Healthcare Provider Details

I. General information

NPI: 1902737406
Provider Name (Legal Business Name): MARIELOS IVONNE POSADA POSADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 15TH ST. NE, SUITE 104
NORTON VA
24273
US

IV. Provider business mailing address

96 15TH ST. NE, SUITE 104
NORTON VA
24273
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-0321
  • Fax:
Mailing address:
  • Phone: 276-679-0321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116041771
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: