Healthcare Provider Details

I. General information

NPI: 1346659745
Provider Name (Legal Business Name): BETHZAIDA FELIX-SANTIAGO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2014
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 GALLOWS RD
FALLS CHURCH VA
22042-3353
US

IV. Provider business mailing address

3302 GALLOWS RD
FALLS CHURCH VA
22042-3353
US

V. Phone/Fax

Practice location:
  • Phone: 703-207-7100
  • Fax:
Mailing address:
  • Phone: 703-207-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number06574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: