Individual
IRISA YE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3300
(703) 776-6141
Mailing address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3300
(703) 776-6141
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0116041364
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/25/2024
Last updated
07/02/2025
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