Healthcare Provider Details

I. General information

NPI: 1669549192
Provider Name (Legal Business Name): ANDROMEDA TRANSCULTURAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 DECATUR ST NW
WASHINGTON DC
20011-4343
US

IV. Provider business mailing address

1400 DECATUR ST NW
WASHINGTON DC
20011-4343
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-4707
  • Fax: 202-723-4560
Mailing address:
  • Phone: 202-291-4707
  • Fax: 202-723-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI100000775
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0069798
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR185465
License Number StateDC
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD036433
License Number StateDC

VIII. Authorized Official

Name: DR. ALVARO GUZMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 202-291-4707