Individual
MR. CARLOS FAGBENRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
6360 HOADLY RD, MANASSAS, VA 20112-3422
(571) 594-9110
Mailing address
15337 LORD CULPEPER CT, WOODBRIDGE, VA 22191-4937
(571) 594-9110
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024169586
VA
Other
Enumeration date
12/07/2011
Last updated
01/27/2017
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