=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881930253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARLINGTON PEDIATRIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2012
-----------------------------------------------------
Last Update Date | 12/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 S CARLIN SPRINGS RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204-1044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-271-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 S CARLIN SPRINGS RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204-1044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-271-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. GONZALO PAZ-SOLDAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 703-271-8109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 0904001756
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | 0904001756
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------