Provider Demographics
NPI:1205147311
Name:REFQ, SORAIA (DPM)
Entity type:Individual
Prefix:
First Name:SORAIA
Middle Name:
Last Name:REFQ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304
Mailing Address - Country:US
Mailing Address - Phone:703-379-0700
Mailing Address - Fax:703-578-4161
Practice Address - Street 1:4600 KENMORE AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-379-0700
Practice Address - Fax:703-578-4161
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301124213ES0103X
PASC006181213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery