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General NPI Number Information
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NPI Number | 1912175613
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Entity Type | Organization
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Legal Business Name | TAKOMA FAMILY HEALTH CENTER, LLC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 7676 NEW HAMPSHIRE AVE #418
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City | TAKOMA PARK
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State | MD
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Zip | 20912
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Country | US
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Telephone | 301-431-0160
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Fax | 301-431-0163
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Provider Business Mailing Address
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Address Line | 7676 NEW HAMPSHIRE AVE #418
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City | TAKOMA PARK
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State | MD
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Zip | 20912
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Country | US
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Telephone | 301-431-0160
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Fax | 301-431-0163
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Authorized Official
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Title or Position | CEO
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Name | MRS. SILVIA TRUJILLO
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Credential | MEDICAL OFFICE SPEC
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Telephone | 301-431-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | D0030235
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0033588
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License Number State | MD
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