=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770990764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIBEIRO FOOT AND ANKLE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2014
-----------------------------------------------------
Last Update Date | 05/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4660 KENMORE AVE STE 602
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-637-9917
-----------------------------------------------------
Fax | 703-566-5201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4660 KENMORE AVE STE 602
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-637-9917
-----------------------------------------------------
Fax | 703-566-5201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. CARLA RIBEIRO-BACHTELL
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 703-637-9917
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------