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General NPI Number Information
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NPI Number | 1568866671
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Entity Type | Individual
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Provider Name | LUIS ALBERTO PEDEMONTE ACNP
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Gender | Male
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD ORIGINAL BUILDING, 2ND FLOOR
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-4958
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Fax |
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Provider Business Mailing Address
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Address Line | 45572 SILVER POND SQ APT 201
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-6589
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Country | US
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Telephone | 571-214-3724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0024171985
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License Number State | VA
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