Healthcare Provider Details

I. General information

NPI: 1114396777
Provider Name (Legal Business Name): DARIA TZU LIE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13901 METROTECH DR
CHANTILLY VA
20151-3234
US

IV. Provider business mailing address

7330 HERITAGE VILLAGE PLAZA #102
GAINESVILLE VA
20155
US

V. Phone/Fax

Practice location:
  • Phone: 540-428-1715
  • Fax: 540-779-0028
Mailing address:
  • Phone: 540-428-1715
  • Fax: 540-779-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09983
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009208
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: