Healthcare Provider Details

I. General information

NPI: 1699341859
Provider Name (Legal Business Name): NUEVA VITA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 MUSGROVE RD STE 302
SILVER SPRING MD
20904-5202
US

IV. Provider business mailing address

2415 MUSGROVE RD STE 302
SILVER SPRING MD
20904-5202
US

V. Phone/Fax

Practice location:
  • Phone: 301-337-2295
  • Fax: 301-804-1752
Mailing address:
  • Phone: 301-337-2295
  • Fax: 301-809-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA A. MARTIN
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 703-626-5230