Healthcare Provider Details

I. General information

NPI: 1932792116
Provider Name (Legal Business Name): MARIEFE GUANLAO CAFUIR CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4176 S PLAZA TRL STE 217
VIRGINIA BEACH VA
23452-1920
US

IV. Provider business mailing address

209 VERDE ST
VIRGINIA BEACH VA
23462-4419
US

V. Phone/Fax

Practice location:
  • Phone: 757-401-4435
  • Fax:
Mailing address:
  • Phone: 757-650-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202008244
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: