| Hispanic American Pediatric Associates | |
|
5130 Duke Street Suite 7 Alexandria VA 22304-7207 | |
| (703) 751-2021 | |
| (703) 751-2071 |
| Full Name | Hispanic American Pediatric Associates |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 5130 Duke Street, Alexandria, Virginia |
| Authorized Official Name and Position | Jemal Omidvar (PRESIDENT) |
| Authorized Official Contact | 7037512021 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Hispanic American Pediatric Associates 5130 Duke St Ste 7 Suite 229 Alexandria VA 22304-2955 Ph: (703) 751-2021 | Hispanic American Pediatric Associates 5130 Duke Street Suite 7 Alexandria VA 22304-7207 Ph: (703) 751-2021 |
| NPI Number | 1386719524 |
|---|---|
| Provider Enumeration Date | 11/22/2006 |
| Last Update Date | 01/30/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386719524 | NPI | - | NPPES |
| 010117534 | Medicaid | VA | |
| 002632800 | Medicaid | MD | |
| 010125561 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 40990-01 (Virginia) | Primary |
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