Provider Demographics
NPI:1679971279
Name:KALUGDAN, IRVIN
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:
Last Name:KALUGDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5459 MITTENDORFF LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3906
Mailing Address - Country:US
Mailing Address - Phone:202-627-0072
Mailing Address - Fax:
Practice Address - Street 1:5459 MITTENDORFF LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3906
Practice Address - Country:US
Practice Address - Phone:202-627-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist