Provider Demographics
NPI:1528702396
Name:CARLY ONOPA NUTRITION, LLC
Entity type:Organization
Organization Name:CARLY ONOPA NUTRITION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONOPA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LDN, CEDS-C
Authorized Official - Phone:703-348-5271
Mailing Address - Street 1:10560 MAIN ST STE 410C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7131
Mailing Address - Country:US
Mailing Address - Phone:703-348-5271
Mailing Address - Fax:703-995-4587
Practice Address - Street 1:10560 MAIN ST STE 410C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7131
Practice Address - Country:US
Practice Address - Phone:703-348-5271
Practice Address - Fax:703-995-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty