| NPI | 1821584921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARANGELY NAZARIO Credentialing Manager 202-420-7175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2019-09-17 |