Healthcare Provider Details

I. General information

NPI: 1558076778
Provider Name (Legal Business Name): RISE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 I ST NW STE 550
WASHINGTON DC
20006-4069
US

IV. Provider business mailing address

1634 I ST NW STE 550
WASHINGTON DC
20006-4069
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-7473
  • Fax: 202-596-7473
Mailing address:
  • Phone: 202-596-7473
  • Fax: 202-596-7473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIAN ARTUNDUAGA
Title or Position: CEO
Credential: DO
Phone: 202-596-7473