Provider Demographics
NPI:1376062836
Name:VIRGINIA INTEGRATIVE PRACTICE
Entity Type:Organization
Organization Name:VIRGINIA INTEGRATIVE PRACTICE
Other - Org Name:VIVA CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VAJRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-299-4570
Mailing Address - Street 1:8996 BURKE LAKE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1607
Mailing Address - Country:US
Mailing Address - Phone:888-299-4570
Mailing Address - Fax:888-398-0897
Practice Address - Street 1:8996 BURKE LAKE RD STE 303
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1607
Practice Address - Country:US
Practice Address - Phone:888-299-4570
Practice Address - Fax:888-398-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242686207R00000X
VA0101244564207V00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty