Healthcare Provider Details

I. General information

NPI: 1003567868
Provider Name (Legal Business Name): XIMENA NATALIA RODRIGUEZ LUJAN LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 S GLEBE RD STE E
ARLINGTON VA
22206-2730
US

IV. Provider business mailing address

4501 HAZELTINE CT UNIT D
ALEXANDRIA VA
22312-3202
US

V. Phone/Fax

Practice location:
  • Phone: 703-535-8887
  • Fax:
Mailing address:
  • Phone: 202-341-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126003183
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: