Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 0101043241 | VA |
NPI | 1366587198 |
---|---|
Provider Name | Maria Dolores Encarnacion |
First Address | Willis, VA 24380-4653 |
Second Address | Willis, VA 24380-4652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |