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General NPI Number Information
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NPI Number | 1033092259
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Entity Type | Organization
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Legal Business Name | GSS PROVITA SERVICES LLC
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 9711 WASHINGTONIAN BLVD STE 550
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City | GAITHERSBURG
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State | MD
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Zip | 20878-5789
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Country | US
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Telephone | 240-949-4034
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Fax |
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Provider Business Mailing Address
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Address Line | 150 MONROE ST APT 101
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City | ROCKVILLE
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State | MD
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Zip | 20850-2518
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Country | US
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Telephone | 240-222-2667
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | GUILLANA SIMON
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Credential | CRNP
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Telephone | 240-222-2667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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