Individual
BAHIA CHACAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6311 RICHMOND HWY, ALEXANDRIA, VA 22306-6410
(703) 647-6087
Mailing address
11350 MCCORMICK RD, HUNT VALLEY, MD 21031-1002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110008119
VA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/23/2021
Last updated
09/14/2022
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