Healthcare Provider Details

I. General information

NPI: 1811666324
Provider Name (Legal Business Name): URSULA D SANABRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 LOISDALE CT
SPRINGFIELD VA
22150-1826
US

IV. Provider business mailing address

12022 TORREY PINE CT
WOODBRIDGE VA
22192-1417
US

V. Phone/Fax

Practice location:
  • Phone: 703-358-7979
  • Fax:
Mailing address:
  • Phone: 703-496-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number0120008814
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: