Healthcare Provider Details

I. General information

NPI: 1700713609
Provider Name (Legal Business Name): ABDULRAHMAN ALADHAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10432 BALLS FORD RD
MANASSAS VA
20109-2514
US

IV. Provider business mailing address

7812 MCLEAN ST
MANASSAS VA
20111-2123
US

V. Phone/Fax

Practice location:
  • Phone: 202-519-0079
  • Fax:
Mailing address:
  • Phone: 202-519-0079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: