Healthcare Provider Details

I. General information

NPI: 1346500832
Provider Name (Legal Business Name): KYLA PATEK M.S., C.G.C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR SUITE 190
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

1635 N GEORGE MASON DR SUITE 190
ARLINGTON VA
22205-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-6077
  • Fax: 703-558-6015
Mailing address:
  • Phone: 703-558-6077
  • Fax: 703-558-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: