Healthcare Provider Details

I. General information

NPI: 1588809966
Provider Name (Legal Business Name): URMILA MOTA MS,RD,LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4375 FAIR LAKES CT
FAIRFAX VA
22033-4234
US

IV. Provider business mailing address

4206 MARBLE LN
FAIRFAX VA
22033-3126
US

V. Phone/Fax

Practice location:
  • Phone: 571-432-2600
  • Fax: 571-432-2788
Mailing address:
  • Phone: 601-842-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX5221
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: