Healthcare Provider Details

I. General information

NPI: 1609644178
Provider Name (Legal Business Name): VIRTUAL FERTILITY MANAGEMENT E-CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 COX RD STE 285
GLEN ALLEN VA
23060-6808
US

IV. Provider business mailing address

85 ROSEWOOD DR
BARBOURSVILLE VA
22923-8569
US

V. Phone/Fax

Practice location:
  • Phone: 540-418-6800
  • Fax:
Mailing address:
  • Phone: 540-418-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA MONIQUE DIONES PANGATONGAN
Title or Position: OWNER
Credential: FNP-C
Phone: 540-418-6800