Healthcare Provider Details

I. General information

NPI: 1528972189
Provider Name (Legal Business Name): CERTITEST MOBILE COMPLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21650 FRAME SQ
BROADLANDS VA
20148-5015
US

IV. Provider business mailing address

21650 FRAME SQ
BROADLANDS VA
20148-5015
US

V. Phone/Fax

Practice location:
  • Phone: 703-201-2164
  • Fax:
Mailing address:
  • Phone: 703-201-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: RONDIE SIMPSON
Title or Position: COO
Credential:
Phone: 703-201-2164