Healthcare Provider Details

I. General information

NPI: 1982727327
Provider Name (Legal Business Name): STEPHANIE MARIE PINA ND, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 EXECUTIVE PARK AVENUE #300
FAIRFAX VA
22031-4647
US

IV. Provider business mailing address

8500 EXECUTIVE PARK AVENUE #300
FAIRFAX VA
22031-4647
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-7117
  • Fax: 703-698-5729
Mailing address:
  • Phone: 703-698-7117
  • Fax: 703-698-5729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number05-888
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000598
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: