Provider Demographics
NPI:1669549192
Name:ANDROMEDA TRANSCULTURAL HEALTH
Entity type:Organization
Organization Name:ANDROMEDA TRANSCULTURAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position: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:2006-11-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000775133V00000X
DCD0069798207Q00000X
207Q00000X, 2084B0040X, 261Q00000X
DCR185465363LF0000X
DCMD0364332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC060850700Medicaid
DC086232900Medicaid
DC7420133OtherAETNA
DC037625600Medicaid
DC0168504OtherUNITED HEALTH CARE
DC5840OtherBCBS
DC086232900Medicaid
DC0168504OtherUNITED HEALTH CARE