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General NPI Number Information
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NPI Number | 1982145058
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Entity Type | Individual
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Provider Name | MALGORZATA BOOTH L.AC.
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Gender | Female
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 520 N WASHINGTON ST STE 100
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3538
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Country | US
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Telephone | 703-300-0797
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Fax |
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Provider Business Mailing Address
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Address Line | 18841 ACCOKEEK TER
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City | LEESBURG
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State | VA
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Zip | 20176-8453
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Country | US
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Telephone | 703-300-0797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121000836
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License Number State | VA
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