Healthcare Provider Details

I. General information

NPI: 1801643820
Provider Name (Legal Business Name): SOFIA ANA BRAMANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 FAIRFAX DR STE 120
ARLINGTON VA
22203-1613
US

IV. Provider business mailing address

4401 4TH ST N APT 333
ARLINGTON VA
22203-3042
US

V. Phone/Fax

Practice location:
  • Phone: 703-292-4060
  • Fax:
Mailing address:
  • Phone: 203-520-5348
  • 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: