| NPI | 1922335561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELWIN G BUSTOS CEO 202-269-6430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: DC MD19909) |
| Additional Taxonomies | 207RN0300X Internal Medicine Nephrology |
| 261QP2300X Clinic/Center Primary Care | |
| 302F00000X Exclusive Provider Organization | |
| 302R00000X Health Maintenance Organization | |
| 305R00000X Preferred Provider Organization | |
| 305S00000X Point of Service | |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2024-10-11 |