# KENT VILLAGE MEDICAL CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578979886
- **Authorized official:** DR. FEDERICO CARLOS GONZALES M.D. (OWNER)
- **Authorized official phone:** (703) 715-9700

## Contact information

- **Practice address:** 112 KENT VILLAGE SQ, MANASSAS PARK, VA 20111-4155
- **Practice address phone:** (703) 715-9700
- **Practice address fax:** (703) 715-0202
- **Mailing address:** 3700 JOSEPH SIEWICK DR, SUITE 401, FAIRFAX, VA 22033-1744
- **Mailing address phone:** (703) 715-9700
- **Mailing address fax:** (703) 715-0202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QU0200X | Urgent Care Clinic/Center | 0101028651 | VA | Yes |

## Other

- **Enumeration date:** 07/08/2014
- **Last updated:** 07/08/2014