1275768608 NPI number — ANA RAQUEL ZEBALLOS F.N.P.

Table of content: (NPI 1366853939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275768608 NPI number — ANA RAQUEL ZEBALLOS F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZEBALLOS
Provider First Name:
ANA
Provider Middle Name:
RAQUEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275768608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37174
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-3174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-423-5699
Provider Business Mailing Address Fax Number:
571-423-5698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 ARLINGTON BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-2336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-531-3100
Provider Business Practice Location Address Fax Number:
703-531-3101
Provider Enumeration Date:
05/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AC001616 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024173147 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)