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General NPI Number Information
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NPI Number | 1326851064
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Entity Type | Organization
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Legal Business Name | REFREVA LLC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1035 STERLING RD STE 104
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City | HERNDON
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State | VA
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Zip | 20170-3838
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Country | US
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Telephone | 571-363-5182
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Fax |
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Provider Business Mailing Address
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Address Line | 1035 STERLING RD STE 104
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City | HERNDON
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State | VA
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Zip | 20170-3838
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Country | US
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Telephone | 571-363-5182
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | SALMAN KHAN
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Credential |
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Telephone | 786-788-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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