Healthcare Provider Details

I. General information

NPI: 1366323628
Provider Name (Legal Business Name): ADIA XABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MAIN DR NW
WASHINGTON DC
20012-2822
US

IV. Provider business mailing address

815 PERSHING DR
SILVER SPRING MD
20910-4489
US

V. Phone/Fax

Practice location:
  • Phone: 202-808-9033
  • Fax:
Mailing address:
  • Phone: 202-274-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: