Provider Demographics
NPI:1184157802
Name:JALALA, SAMARA
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:JALALA
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 1:3701 S. GEORGE MASON DR.
Mailing Address - Street 2:SUITE C2N
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041
Mailing Address - Country:US
Mailing Address - Phone:703-989-7731
Mailing Address - Fax:
Practice Address - Street 1:3701 S GEORGE MASON DR
Practice Address - Street 2:SUITE C2N
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3758
Practice Address - Country:US
Practice Address - Phone:703-989-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171000000X, 174400000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171000000XOther Service ProvidersMilitary Health Care Provider
No174400000XOther Service ProvidersSpecialist