Provider Demographics
NPI:1790140903
Name:REDICLINIC OF VA, LLC
Entity Type:Organization
Organization Name:REDICLINIC OF VA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-580-9489
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:713-335-1731
Mailing Address - Fax:713-574-2794
Practice Address - Street 1:2260A HUNTERS WOODS PLZ
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-2898
Practice Address - Country:US
Practice Address - Phone:713-358-4881
Practice Address - Fax:713-358-4881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDICLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-15
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center