Provider Demographics
NPI:1235525692
Name:ANDROMEDA TRANSCULTURAL HEALTH
Entity Type:Organization
Organization Name:ANDROMEDA TRANSCULTURAL HEALTH
Other - Org Name:ANDROMEDA TRANSCULTURAL HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-291-4707
Mailing Address - Street 1:1400 DECATUR ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4343
Mailing Address - Country:US
Mailing Address - Phone:202-291-4707
Mailing Address - Fax:202-723-4560
Practice Address - Street 1:1400 DECATUR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4343
Practice Address - Country:US
Practice Address - Phone:202-291-4707
Practice Address - Fax:202-723-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
DCPH100000948261QC1500X
VA0202209782261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1568634590Medicaid