Healthcare Provider Details

I. General information

NPI: 1639780323
Provider Name (Legal Business Name): LAURA ANN CINTORINO RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3908
  • Fax:
Mailing address:
  • Phone: 703-391-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001132859
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: