=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144787276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPRING VALLEY PEDIATRICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2019
-----------------------------------------------------
Last Update Date | 02/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4900 MASSACHUSETTS AVE NW LOWR LEVEL
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20016-4358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-966-5000
-----------------------------------------------------
Fax | 202-966-5810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4900 MASSACHUSETTS AVE NW LOWR LEVEL
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20016-4358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-966-5000
-----------------------------------------------------
Fax | 202-966-5810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | CYNTHIA GUNERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-966-5000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------