Healthcare Provider Details

I. General information

NPI: 1316135403
Provider Name (Legal Business Name): KAVITHA FELIX - JOHNSON RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAPLE AVE W SUITE 120
VIENNA VA
22180-4301
US

IV. Provider business mailing address

301 MAPLE AVE W SUITE 120
VIENNA VA
22180-4301
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-8885
  • Fax: 703-242-2437
Mailing address:
  • Phone: 703-938-8885
  • Fax: 703-242-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: