Healthcare Provider Details

I. General information

NPI: 1427592880
Provider Name (Legal Business Name): CRISTINA MARIA CARTAGENA COA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6231 LEESBURG PIKE SUITE 608
FALLS CHURCH VA
22044-2102
US

IV. Provider business mailing address

9605 LITTLE COBBLER CT
BURKE VA
22015-4133
US

V. Phone/Fax

Practice location:
  • Phone: 703-534-3900
  • Fax:
Mailing address:
  • Phone: 571-447-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1101X
TaxonomyOphthalmic Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: