Healthcare Provider Details

I. General information

NPI: 1235525692
Provider Name (Legal Business Name): ANDROMEDA TRANSCULTURAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 01/08/2018
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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number0202209782
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberPH100000948
License Number StateDC

VIII. Authorized Official

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