Healthcare Provider Details

I. General information

NPI: 1073276598
Provider Name (Legal Business Name): CILICIA HUFANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/21/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VINSON HALL COMMUNITY BUILDING 1735 KIRBY ROAD
MCLEAN VA
22101
US

IV. Provider business mailing address

10816 WOODHAVEN DR
FAIRFAX VA
22030-4828
US

V. Phone/Fax

Practice location:
  • Phone: 703-536-4344
  • Fax:
Mailing address:
  • Phone: 703-896-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: