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General NPI Number Information
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NPI Number | 1417217480
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Entity Type | Organization
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Legal Business Name | SOUTHWEST WOMEN'S HEALTH SERVICES OF VIRGINIA, PLLC
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 05/23/2012
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Provider Practice Location Address
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Address Line | 127 CALLAHAN AVE
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City | APPALACHIA
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State | VA
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Zip | 24216-1203
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Country | US
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Telephone | 276-565-2425
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Fax | 276-565-2427
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Provider Business Mailing Address
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Address Line | 127 CALLAHAN AVE
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City | APPALACHIA
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State | VA
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Zip | 24216-1203
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Country | US
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Telephone | 276-565-2425
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Fax | 276-565-2427
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Authorized Official
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Title or Position | OWNER
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Name | DR. RODOLFO CARTAGENA
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Credential | M.D
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Telephone | 276-565-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101028013
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License Number State | VA
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