MEDICARE: MARITA ISABEL ASEDILLO

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	106S00000X	Behavior Technician		VA

General Provider Information

NPI Number	:	1548111859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITA ISABEL ASEDILLO

Provider Business Mailing Address
First Line	:	42522 HARVEST HORN WAY
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 VANCOUVER RD
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-3350
Country	:	US
Telephone Number	:	703-828-7596
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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