MEDICARE: JOSH PATRICIA ALBA BALMEDIANO RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian

General Provider Information

NPI Number	:	1043998834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSH PATRICIA ALBA BALMEDIANO RD

Provider Business Mailing Address
First Line	:	2105 N GLEBE RD UNIT 2311
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-2236
Country	:	US
Telephone Number	:	843-597-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	4820 31ST ST S STE B
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-1665
Country	:	US
Telephone Number	:	703-865-6490
Fax Number	:	703-865-6542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/11/2023

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