1316091812 NPI number — MRS. KARLA TERESA ALBRACHT LICENSED CLERICAL SO

Table of content: MRS. KARLA TERESA ALBRACHT LICENSED CLERICAL SO (NPI 1316091812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316091812 NPI number — MRS. KARLA TERESA ALBRACHT LICENSED CLERICAL SO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBRACHT
Provider First Name:
KARLA
Provider Middle Name:
TERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED CLERICAL SO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JEREZ
Provider Other First Name:
KARLA
Provider Other Middle Name:
TERESA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316091812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5305 ORCHARDSON COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10560 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE #410
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-352-8538
Provider Business Practice Location Address Fax Number:
703-352-9040
Provider Enumeration Date:
01/22/2007

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: 1041C0700X , with the licence number:  0904005039 , 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)





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