Healthcare Provider Details

I. General information

NPI: 1770356685
Provider Name (Legal Business Name): LOTUS WELLNESS AND ESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PIDGEON HILL DR STE 311
STERLING VA
20165-6182
US

IV. Provider business mailing address

24747 TRIBE SQ APT 102
DULLES VA
20166-2645
US

V. Phone/Fax

Practice location:
  • Phone: 703-977-8198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALDECIA MATTHEWS
Title or Position: OWNER
Credential:
Phone: 571-771-9383