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General NPI Number Information
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NPI Number | 1467045682
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Entity Type | Organization
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Legal Business Name | CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 1901 N BEAUREGARD ST STE 110
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1721
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Country | US
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Telephone | 313-407-3807
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Fax |
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Provider Business Mailing Address
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Address Line | 21750 HARDY OAK BLVD STE 104 PMB 72961
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4946
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOSE ALFREDO MARTINEZ
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Credential |
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Telephone | 949-668-4902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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