Healthcare Provider Details

I. General information

NPI: 1467763235
Provider Name (Legal Business Name): MRS. MARIA CHONA DECASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MARIA CHONA FORLALES

II. Dates (important events)

Enumeration Date: 06/27/2010
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4490 HOLLAND OFFICE PARK STE 101
VIRGINIA BEACH VA
23452-1177
US

IV. Provider business mailing address

801 CABRINI PL
VIRGINIA BEACH VA
23464-1769
US

V. Phone/Fax

Practice location:
  • Phone: 757-639-2218
  • Fax: 866-594-3899
Mailing address:
  • Phone: 757-339-4198
  • Fax: 757-962-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: