Healthcare Provider Details

I. General information

NPI: 1720765456
Provider Name (Legal Business Name): VALERY FRU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-3865
US

IV. Provider business mailing address

10911 FLEETWOOD DR
BELTSVILLE MD
20705-2503
US

V. Phone/Fax

Practice location:
  • Phone: 202-894-6811
  • Fax:
Mailing address:
  • Phone: 781-975-0851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: