Healthcare Provider Details

I. General information

NPI: 1962434704
Provider Name (Legal Business Name): RENE LLANERAS & GUILLERMO TREMOLS PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 CLUBHOUSE ROAD SUITE 101
RESTON VA
20190-4595
US

IV. Provider business mailing address

1712 CLUBHOUSE ROAD SUITE 101
RESTON VA
20190-4595
US

V. Phone/Fax

Practice location:
  • Phone: 703-470-5770
  • Fax: 703-471-5771
Mailing address:
  • Phone: 703-470-5770
  • Fax: 703-471-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101020286
License Number StateVA

VIII. Authorized Official

Name: DR. GUILLERMO A TREMOLS
Title or Position: PARTNER
Credential: MD
Phone: 703-471-5770