=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194510115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIESTA HEALTH SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3763 FETTLER PARK DR
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22025-1946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-938-9996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13036 BRIERLY FOREST CT
-----------------------------------------------------
City | MANASSAS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20112-8869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-938-9996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MASHKOUR RAB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-969-3844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS1201X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------