Healthcare Provider Details

I. General information

NPI: 1952128308
Provider Name (Legal Business Name): CLINIBOOTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42148 STONE PRESS TER
BRAMBLETON VA
20148-6525
US

IV. Provider business mailing address

42148 STONE PRESS TER
BRAMBLETON VA
20148-6525
US

V. Phone/Fax

Practice location:
  • Phone: 937-581-8921
  • Fax: 844-592-1154
Mailing address:
  • Phone: 937-581-8921
  • Fax: 844-592-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEEPAK SALUJA
Title or Position: CEO
Credential: MD
Phone: 937-581-8921