Individual
JAMIELOU CUSTODIO BRECKENRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(571) 231-3224
Mailing address
9300 DEWITT LOOP, FORT BELVOIR, VA 22060-5285
(571) 231-3224
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101276676
VA
Other
Enumeration date
01/25/2017
Last updated
09/06/2024
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