Healthcare Provider Details

I. General information

NPI: 1174627129
Provider Name (Legal Business Name): CHRISTINA FUENTES FRAYNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6231 LEESBURG PIKE STE 203
FALLS CHURCH VA
22044-2102
US

IV. Provider business mailing address

6231 LEESBURG PIKE STE 203
FALLS CHURCH VA
22044-2102
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-6811
  • Fax: 703-752-4747
Mailing address:
  • Phone: 703-237-6811
  • Fax: 703-752-4747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101053435
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: