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General NPI Number Information
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NPI Number | 1972362796
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Entity Type | Organization
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Legal Business Name | THE PROVIDENCIA GROUP
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 19775 BELMONT EXECUTIVE PLZ STE 450
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City | ASHBURN
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State | VA
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Zip | 20147-7606
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Country | US
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Telephone | 571-431-1458
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Fax |
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Provider Business Mailing Address
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Address Line | 7773 WAIKAPU LOOP
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City | HONOLULU
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State | HI
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Zip | 96825-3026
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Country | US
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Telephone | 808-282-1840
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KEVIN MARQUEZ
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Credential |
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Telephone | 571-223-4629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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