Healthcare Provider Details

I. General information

NPI: 1396747812
Provider Name (Legal Business Name): JOSEFINA CABAHUG HEYRANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7906 ANDRUS RD SUITE 8
ALEXANDRIA VA
22306-3168
US

IV. Provider business mailing address

7914 WILLFIELD CT
FAIRFAX STATION VA
22039-3180
US

V. Phone/Fax

Practice location:
  • Phone: 703-780-7034
  • Fax: 703-780-1379
Mailing address:
  • Phone: 703-643-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101051218
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: