Healthcare Provider Details

I. General information

NPI: 1336697051
Provider Name (Legal Business Name): ALL FEMALE OB/GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14631 LEE HWY #405
CENTREVILLE VA
20121-5824
US

IV. Provider business mailing address

3009 JAMESTOWN CT
WOODBRIDGE VA
22192-3213
US

V. Phone/Fax

Practice location:
  • Phone: 703-830-1950
  • Fax:
Mailing address:
  • Phone: 703-626-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number0024173959
License Number StateVA

VIII. Authorized Official

Name: MRS. ANGELA GARCIA
Title or Position: FNP
Credential: FNP, MSN
Phone: 703-626-4406