Xyz Clinic
Physician Assistant, Medical in Fairfax, VA. Organization (NPI-2).
NPI number1760633283
StatusActive
Last updated in NPPESOct 2, 2008
Details
- NPI
- 1760633283
- Entity type
- Organization (NPI-2)
- Legal business name
- Xyz Clinic
- Organization subpart
- No
- Enumeration date
- Oct 2, 2008
- Last updated
- Oct 2, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 908832094382904 | VA | Yes |
Practice location
17000 Breeze LaneFairfax, VA 22033
Phone 703-777-2222
Mailing address
17000 Breeze LaneFairfax, VA 22033
Phone 703-777-2222
Authorized official
Jim Smith
Administrator
7037772222
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