Healthcare Provider Details

I. General information

NPI: 1982145058
Provider Name (Legal Business Name): MALGORZATA BOOTH L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N WASHINGTON ST STE 100
FALLS CHURCH VA
22046-3538
US

IV. Provider business mailing address

18841 ACCOKEEK TER
LEESBURG VA
20176-8453
US

V. Phone/Fax

Practice location:
  • Phone: 703-300-0797
  • Fax:
Mailing address:
  • Phone: 703-300-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000836
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: