Healthcare Provider Details

I. General information

NPI: 1427443670
Provider Name (Legal Business Name): NATURAL INTEGRATIVE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6907 BRIMSTONE LN
FAIRFAX STATION VA
22039-1819
US

IV. Provider business mailing address

6907 BRIMSTONE LN
FAIRFAX STATION VA
22039-1819
US

V. Phone/Fax

Practice location:
  • Phone: 703-250-3424
  • Fax:
Mailing address:
  • Phone: 703-250-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0053
License Number StateDC

VIII. Authorized Official

Name: DR. PATRICIA L DIEFENBACH
Title or Position: NATUROPATHIC PHYSICIAN
Credential: ND
Phone: 703-609-8717