Provider Demographics
NPI:1528754496
Name:STAYING AGELESS INC.
Entity type:Organization
Organization Name:STAYING AGELESS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO &CERTIFIED NUTRITION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ESOSA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDOSOMWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CNS, LDN
Authorized Official - Phone:650-797-8890
Mailing Address - Street 1:10780 WESTVIEW DR STE F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-5038
Mailing Address - Country:US
Mailing Address - Phone:202-719-5295
Mailing Address - Fax:
Practice Address - Street 1:1530 W SAM HOUSTON PKWY N STE 117
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-3159
Practice Address - Country:US
Practice Address - Phone:202-719-5295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty