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Organization
KENKO PLLC
Active
Organization
KENKO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA CASAMALHUAPA MD (OWNER)
(703) 485-0470
Entity
Organization
Contact information
Practice address
14130 NOBLEWOOD PLZ STE 301, WOODBRIDGE, VA 22193-1467
(703) 485-0470
Mailing address
14130 NOBLEWOOD PLZ STE 301, WOODBRIDGE, VA 22193-1467
(703) 485-0470
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
208000000X
Pediatrics Physician
—
—
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
07/17/2023
Last updated
07/17/2023
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