Healthcare Provider Details

I. General information

NPI: 1174442230
Provider Name (Legal Business Name): YUBERKYS SOLLA OVALLES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 RESTON STATION BLVD APT 373
RESTON VA
20190-5419
US

IV. Provider business mailing address

11410 RESTON STATION BLVD APT 373
RESTON VA
20190-5419
US

V. Phone/Fax

Practice location:
  • Phone: 240-476-4760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001846
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: