=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548987399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERSIDE INTEGRATED HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2022
-----------------------------------------------------
Last Update Date | 10/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2034 EISENHOWER AVE STE 100
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-298-2424
-----------------------------------------------------
Fax | 866-545-1147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2034 EISENHOWER AVE STE 100
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22314-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-298-2424
-----------------------------------------------------
Fax | 866-545-1147
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WALEED M ABUL-HAWA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 703-298-2424
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------