Individual
GRACE CRUZ BANEZ SESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-1110
Mailing address
PO BOX 221322, CHANTILLY, VA 20153-1322
(703) 691-1494
(703) 691-3526
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101243543
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972770683
HIGHMARK MEDICARE
—
05
—
1972770683
—
VA
Enumeration date
05/12/2008
Last updated
01/24/2009
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