Healthcare Provider Details

I. General information

NPI: 1174439905
Provider Name (Legal Business Name): RIO MARASIGAN PORNESO MSN, APRN, AGPCNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR STE 310
FAIRFAX VA
22033-1715
US

IV. Provider business mailing address

5501 BROOKLAND RD
ALEXANDRIA VA
22310-1806
US

V. Phone/Fax

Practice location:
  • Phone: 703-758-8800
  • Fax:
Mailing address:
  • Phone: 202-981-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024198477
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024198477
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024198477
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: