NPI 1104343532 · live from the CMS NPI Registry
Bouloute Healthcare Services, LLC
Podiatrist in Woodbridge, VA. National Provider Identifier 1104343532, active.
NPI record
| NPI | 1104343532 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist 213E00000X |
| Practice location | 5049 Anchorstone Dr, Woodbridge, VA 22192 |
| Practice phone | 678-517-4214 |
| Mailing address | 8653 16th St Unit 7186, Silver Spring, MD 20907 |
| Enumerated | August 25, 2017 |
| Last updated | August 25, 2017 |
| Authorized official | Owmy Bouloute, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist primary | 213E00000X | 01303301212 (VA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.