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General NPI Number Information
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NPI Number | 1023809423
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Entity Type | Organization
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Legal Business Name | LOS 3 VASQUITOS L.L.C.
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 7900 JENSEN PL
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City | BETHESDA
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State | MD
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Zip | 20817-4671
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Country | US
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Telephone | 954-696-4012
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 JENSEN PL
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City | BETHESDA
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State | MD
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Zip | 20817-4671
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Country | US
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Telephone | 202-247-5784
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOSE FELIX ETCHEGOYEN
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Credential |
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Telephone | 202-247-5784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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