Provider Demographics
NPI:1760912109
Name:ROUZBEH, ROZITA (DAC)
Entity Type:Individual
Prefix:
First Name:ROZITA
Middle Name:
Last Name:ROUZBEH
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8454 HOLLY LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2225
Mailing Address - Country:US
Mailing Address - Phone:703-419-0803
Mailing Address - Fax:
Practice Address - Street 1:5627 ALLENTOWN RD STE 101-102
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4520
Practice Address - Country:US
Practice Address - Phone:571-395-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist