Mala Thakur Arguello, MD, PA
Individual provider Active NPI Physician Assistant · Woodbridge, VA
NPI 1104641349 · NPPES record last updated Nov 21, 2024
Key facts
- NPI
- 1104641349
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 002338 (PR)
- Practice address
- 5584 Reardon LN
Woodbridge, VA 22193-3754 - Phone
- (925) 503-9150
- NPI assigned
- Nov 21, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002338 | PR | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 002338 | PR | Yes |
Addresses
Primary practice location
5584 Reardon LN
Woodbridge, VA 22193-3754
Mailing address
5584 Reardon LN
Woodbridge, VA 22193-3754
NPI Registry JSON
{
"created_epoch": "1732147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732147200000",
"number": "1104641349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5584 REARDON LN",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221933754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5584 REARDON LN",
"city": "WOODBRIDGE",
"state": "VA",
"postal_code": "221933754",
"telephone_number": "925-503-9150"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARGUELLO",
"first_name": "MALA",
"middle_name": "THAKUR",
"name_prefix": "Dr.",
"credential": "MD, PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-21",
"last_updated": "2024-11-21",
"certification_date": "2024-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PR",
"license": "002338",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.