Healthcare Provider Details

I. General information

NPI: 1104008820
Provider Name (Legal Business Name): CLINICA FAMILIAR DE ARLINGTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR SUITE 455
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

1635 N GEORGE MASON DR SUITE 455
ARLINGTON VA
22205-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-465-0137
  • Fax: 703-465-0429
Mailing address:
  • Phone: 703-465-0137
  • Fax: 703-465-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number0101232384
License Number StateVA

VIII. Authorized Official

Name: DR. JOHN HOSSEIN MOLAIY
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 703-465-0137