| NPI | 1225417082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE HERNANDEZ Managing Official 804-648-4802 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024164803) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-10-27 |