Healthcare Provider Details

I. General information

NPI: 1255488755
Provider Name (Legal Business Name): UNIVERSAL HEALTH AND WELLNESS CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 DONEGAN DR STE 233
MANASSAS VA
20109-8236
US

IV. Provider business mailing address

7960 DONEGAN DR STE 233
MANASSAS VA
20109-8236
US

V. Phone/Fax

Practice location:
  • Phone: 703-366-3199
  • Fax: 703-366-3644
Mailing address:
  • Phone: 703-366-3199
  • Fax: 703-366-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305005258
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number0104001593
License Number StateVA

VIII. Authorized Official

Name: DR. RAUL B AGUILAR
Title or Position: PRESIDENT
Credential: DPT
Phone: 703-366-3199