Healthcare Provider Details

I. General information

NPI: 1912175613
Provider Name (Legal Business Name): TAKOMA FAMILY HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 NEW HAMPSHIRE AVE #418
TAKOMA PARK MD
20912
US

IV. Provider business mailing address

7676 NEW HAMPSHIRE AVE #418
TAKOMA PARK MD
20912
US

V. Phone/Fax

Practice location:
  • Phone: 301-431-0160
  • Fax: 301-431-0163
Mailing address:
  • Phone: 301-431-0160
  • Fax: 301-431-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0033588
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberD0030235
License Number StateMD

VIII. Authorized Official

Name: MRS. SILVIA TRUJILLO
Title or Position: CEO
Credential: MEDICAL OFFICE SPEC
Phone: 301-431-0160