Healthcare Provider Details

I. General information

NPI: 1306187323
Provider Name (Legal Business Name): JUAN A TRINIDAD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2013
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TOWN CENTER DR STE 310
RESTON VA
20190-3215
US

IV. Provider business mailing address

1800 TOWN CENTER DR STE 310
RESTON VA
20190-3215
US

V. Phone/Fax

Practice location:
  • Phone: 703-709-7225
  • Fax:
Mailing address:
  • Phone: 703-709-7225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101018732
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101018732
License Number StateVA

VIII. Authorized Official

Name: DR. JUAN A TRINIDAD
Title or Position: PRESIDENT
Credential: MD
Phone: 703-709-7225