Healthcare Provider Details

I. General information

NPI: 1922781103
Provider Name (Legal Business Name): DILANA DILIXIATI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13285 MINNIEVILLE RD
WOODBRIDGE VA
22192-4018
US

IV. Provider business mailing address

13285 MINNIEVILLE RD
WOODBRIDGE VA
22192-4018
US

V. Phone/Fax

Practice location:
  • Phone: 703-986-2504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0202221005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: