Provider Demographics
NPI:1093313652
Name:HISPANIC AMERICAN PEDIATRICS & FAMILY CARE LLC
Entity Type:Organization
Organization Name:HISPANIC AMERICAN PEDIATRICS & FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:GRACIELA
Authorized Official - Last Name:BUSTAMANTE SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:301-818-7272
Mailing Address - Street 1:2255 CRAIN HWY STE 107
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3186
Mailing Address - Country:US
Mailing Address - Phone:301-818-7272
Mailing Address - Fax:
Practice Address - Street 1:2255 CRAIN HWY STE 107
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3186
Practice Address - Country:US
Practice Address - Phone:301-818-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty