Provider Demographics
NPI:1912175613
Name:TAKOMA FAMILY HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:TAKOMA FAMILY HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL OFFICE SPEC
Authorized Official - Phone:301-431-0160
Mailing Address - Street 1:7676 NEW HAMPSHIRE AVE
Mailing Address - Street 2:#418
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:301-431-0160
Mailing Address - Fax:301-431-0163
Practice Address - Street 1:7676 NEW HAMPSHIRE AVE
Practice Address - Street 2:#418
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-431-0160
Practice Address - Fax:301-431-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033588207R00000X
MDD0030235207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty