Healthcare Provider Details

I. General information

NPI: 1518785997
Provider Name (Legal Business Name): BAIGALMAA BAGI DAGVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLE AVE W
VIENNA VA
22180-4309
US

IV. Provider business mailing address

311 MAPLE AVE W
VIENNA VA
22180-4309
US

V. Phone/Fax

Practice location:
  • Phone: 703-242-3610
  • Fax:
Mailing address:
  • Phone: 703-242-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019010729
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: