Healthcare Provider Details

I. General information

NPI: 1891497764
Provider Name (Legal Business Name): PAOLA XIMENA MONCADA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 ROUTE 29 STE 400
FAIRFAX VA
22031-1847
US

IV. Provider business mailing address

901 HARRY S TRUMAN DR N STE 4217
LARGO MD
20774-5477
US

V. Phone/Fax

Practice location:
  • Phone: 703-383-4836
  • Fax: 703-383-4911
Mailing address:
  • Phone: 240-677-0236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101288328
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: