Provider Demographics
NPI:1730873878
Name:HERNANDEZ BARAZARTE, SABRINA LUCIA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:LUCIA
Last Name:HERNANDEZ BARAZARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45591 DULLES EASTERN PLZ STE 132, BOX 125
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8925
Mailing Address - Country:US
Mailing Address - Phone:786-448-8610
Mailing Address - Fax:
Practice Address - Street 1:43480 YUKON DR STE 204
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6988
Practice Address - Country:US
Practice Address - Phone:703-729-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401419195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist