Healthcare Provider Details

I. General information

NPI: 1134023799
Provider Name (Legal Business Name): LORRAINE GARCIA BEZA AMMERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N MALL DR # 111-122
VIRGINIA BEACH VA
23452-7226
US

IV. Provider business mailing address

1568 HUMMINGBIRD LN
VIRGINIA BEACH VA
23454-5623
US

V. Phone/Fax

Practice location:
  • Phone: 757-598-1217
  • Fax:
Mailing address:
  • Phone: 757-598-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1201116248
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: