Provider Demographics
NPI:1962025502
Name:MEDFREBS, INC
Entity Type:Organization
Organization Name:MEDFREBS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESMERALDA
Authorized Official - Middle Name:ESQUIVEL
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-488-8888
Mailing Address - Street 1:4725 PORTSMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2307
Mailing Address - Country:US
Mailing Address - Phone:757-488-8888
Mailing Address - Fax:757-488-0860
Practice Address - Street 1:4725 PORTSMOUTH BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2307
Practice Address - Country:US
Practice Address - Phone:757-488-8888
Practice Address - Fax:757-488-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care