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General NPI Number Information
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NPI Number | 1962025502
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Entity Type | Organization
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Legal Business Name | MEDFREBS, INC
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Dates
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Enumeration Date | 05/18/2020
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 4725 PORTSMOUTH BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2307
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Country | US
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Telephone | 757-488-8888
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Fax | 757-488-0860
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Provider Business Mailing Address
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Address Line | 4725 PORTSMOUTH BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2307
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Country | US
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Telephone | 757-488-8888
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Fax | 757-488-0860
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Authorized Official
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Title or Position | PRESIDENT/EXECUTIVE DIRECTOR
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Name | MRS. ESMERALDA ESQUIVEL SORIANO
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Credential |
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Telephone | 757-488-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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