Healthcare Provider Details

I. General information

NPI: 1790282911
Provider Name (Legal Business Name): MARIA CECILIA RECOTE LATURNAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 ALLEN ST APT 303
FALLS CHURCH VA
22042-3213
US

IV. Provider business mailing address

3213 ALLEN ST APT 303
FALLS CHURCH VA
22042-3213
US

V. Phone/Fax

Practice location:
  • Phone: 703-599-5707
  • Fax:
Mailing address:
  • Phone: 703-599-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401168208
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: