Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101252814 | VA |
NPI | 1003058538 |
---|---|
Provider Name | Zahir Zoe Jimenez-Tosado |
First Address | Woodbridge, VA 22192 |
Second Address | Woodbridge, VA 22192-8322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 28/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101252814 | VA LICENSE (01) | VA |