Individual
GRETTA HERBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OFFICE ADMINISTRATOR
Contact information
Practice address
3620 JOSEPH SIEWICK DR, SUITE 307, FAIRFAX, VA 22033-1756
(703) 281-1023
(703) 620-2331
Mailing address
3620 JOSEPH SIEWICK DR, SUITE 307, FAIRFAX, VA 22033-1756
(703) 281-1023
(703) 620-2331
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
541148368
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063443802
1063443802
VA
Enumeration date
03/25/2015
Last updated
03/25/2015
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