Provider Demographics
NPI:1710356522
Name:MARY'S CENTER
Entity Type:Organization
Organization Name:MARY'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONCADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-355-4352
Mailing Address - Street 1:3110 MOUNT VERNON AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2646
Mailing Address - Country:US
Mailing Address - Phone:202-355-4352
Mailing Address - Fax:
Practice Address - Street 1:3110 MOUNT VERNON AVE
Practice Address - Street 2:APT. 514
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2664
Practice Address - Country:US
Practice Address - Phone:202-355-4352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN967590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care