Healthcare Provider Details

I. General information

NPI: 1730094533
Provider Name (Legal Business Name): KAREN GONZALEZ-ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STAFFORD AVE
STAFFORD VA
22554-7246
US

IV. Provider business mailing address

1012 JOSHUA LANDING CT
STAFFORD VA
22556-3674
US

V. Phone/Fax

Practice location:
  • Phone: 540-514-8616
  • Fax:
Mailing address:
  • Phone: 540-514-8616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0609625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: