Healthcare Provider Details

I. General information

NPI: 1083489785
Provider Name (Legal Business Name): ELENA SOPHIA IFARRAGUERRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 OLD MEADOW RD STE 600
MC LEAN VA
22102-4323
US

IV. Provider business mailing address

1749 OLD MEADOW RD STE 600
MC LEAN VA
22102-4323
US

V. Phone/Fax

Practice location:
  • Phone: 703-783-3300
  • Fax: 703-783-3300
Mailing address:
  • Phone: 703-783-3300
  • Fax: 703-783-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500014541
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: