Provider Demographics
NPI:1215593975
Name:KHATTAK, ROZEENA ARA
Entity Type:Individual
Prefix:
First Name:ROZEENA
Middle Name:ARA
Last Name:KHATTAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21671 STEATITE CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6787
Mailing Address - Country:US
Mailing Address - Phone:202-380-5504
Mailing Address - Fax:
Practice Address - Street 1:21671 STEATITE CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6787
Practice Address - Country:US
Practice Address - Phone:202-380-5504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator