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General NPI Number Information
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NPI Number | 1417778275
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Entity Type | Organization
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Legal Business Name | GUADALUPE FREE CLINIC
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 700 MCKINNEY BLVD STE 1100
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City | COLONIAL BEACH
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State | VA
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Zip | 22443-1934
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Country | US
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Telephone | 804-224-0571
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Fax | 804-224-0572
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Provider Business Mailing Address
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Address Line | 700 MCKINNEY BLVD STE 1100
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City | COLONIAL BEACH
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State | VA
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Zip | 22443-1934
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Country | US
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Telephone | 804-224-0571
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Fax | 804-224-0572
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. DANIEL MULDOON
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Credential | MD
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Telephone | 540-840-9002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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