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46179 Westlake Dr Ste 330 Sterling VA 20165-5874 | |
| (703) 589-9964 | |
| (571) 252-7100 |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 46179 Westlake Dr Ste 330, Sterling, Virginia |
| Authorized Official Name and Position | Mubin Jiwani (MANAGING MEMBER) |
| Authorized Official Contact | 7035899964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
10622 Runaway Ln Great Falls VA 22066-2420 Ph: (703) 589-9964 | 46179 Westlake Dr Ste 330 Sterling VA 20165-5874 Ph: (703) 589-9964 |
| NPI Number | 1295393791 |
|---|---|
| Provider Enumeration Date | 05/30/2019 |
| Last Update Date | 12/16/2024 |
| Certification Date | 12/16/2024 |
| Medicare PECOS PAC ID | 7618203050 |
|---|---|
| Medicare Enrollment ID | O20190724000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295393791 | NPI | - | NPPES |
| 1548488927 | Medicaid | VA | |
| 1619412673 | Medicaid | VA | |
| 1871007377 | Medicaid | TX | |
| 1619732468 | Medicaid | VA | |
| 1841554912 | Medicaid | VA | |
| 1114459732 | Other | VA | NPI |
| 1174120547 | Medicaid | VA |
| Provider Name | Brandie N Bustillos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548488927 PECOS PAC ID: 2668570706 Enrollment ID: I20070613000296 |
| Provider Name | Zahra Hussain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487176053 PECOS PAC ID: 7012283070 Enrollment ID: I20171019001891 |
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