Provider Demographics
NPI:1003203258
Name:DIEFENBACH, PATRICIA (ND, CNS, CPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:DIEFENBACH
Suffix:
Gender:F
Credentials:ND, CNS, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MOUNT VERNON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1302
Mailing Address - Country:US
Mailing Address - Phone:703-609-8717
Mailing Address - Fax:703-239-1565
Practice Address - Street 1:6907 BRIMSTONE LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1819
Practice Address - Country:US
Practice Address - Phone:703-609-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC0053175F00000X
CT000538175F00000X
2255A2300X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopath
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty