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General NPI Number Information
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NPI Number | 1194241190
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Entity Type | Individual
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Provider Name | SOCORRITO LOUISE BAEZ-PAGE MD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 6204 VENGO CT
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1242
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Country | US
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Telephone | 703-941-1321
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Fax | 703-941-8291
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Provider Business Mailing Address
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Address Line | 6204 VENGO CT
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1242
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Country | US
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Telephone | 703-568-8555
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0101037568
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License Number State | VA
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