Most Relevant Information
Provider Data
| NPI Number: | 1003583014 |
| Provider Name: | HALA D MATA |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | F06212895 |
Most Important Dates
| Enumeration Date: | 08/26/2021 |
| Last Updated: | 09/21/2021 |
Provider Practice Location
3053 NUTLEY ST
FAIRFAX
VA
220311931
Practice Location Phone/Fax
| Phone: | 7035604852 |
| Fax: |
Provider Mailing Location
16024 BARN SWALLOW PL
WOODBRIDGE
VA
221915542
Provider Mailing Phone/Fax
| Phone: | 7036158664 |
| Fax: |