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General NPI Number Information
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NPI Number | 1982078010
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Entity Type | Organization
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Legal Business Name | GHODOUSI LLC
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 5702 GENERAL WASHINGTON DR SUITE G
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City | ALEXANDRIA
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State | VA
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Zip | 22312-2409
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Country | US
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Telephone | 703-224-8985
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Fax |
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Provider Business Mailing Address
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Address Line | 2331 MILL RD SUITE 100
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4677
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Country | US
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Telephone | 571-297-4756
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ARMAN GHODOUSI
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Credential |
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Telephone | 703-224-8985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 15-GTEC
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License Number State | VA
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