Healthcare Provider Details

I. General information

NPI: 1538408240
Provider Name (Legal Business Name): HEARING SOLUTIONS OF FAIRFAX PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 PENDER DR STE 140
FAIRFAX VA
22030-0986
US

IV. Provider business mailing address

3930 PENDER DR STE 140
FAIRFAX VA
22030-0986
US

V. Phone/Fax

Practice location:
  • Phone: 571-432-0640
  • Fax: 571-432-0642
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN MUCCIO
Title or Position: OWNER
Credential:
Phone: 571-432-0640