| NPI | 1922335561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELWIN G BUSTOS Physician 202-269-6430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: DC MD19909) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| 305R00000X Preferred Provider Organization (Licence: DC MD19909) | |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2021-09-24 |