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Organization
WELL-CARE CORP
Active
Organization
WELL-CARE CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS FAGBENRO (OWNER)
(571) 594-9110
Entity
Organization
Contact information
Practice address
4215 DALE BLVD, WOODBRIDGE, VA 22193-2243
(571) 594-9110
(571) 526-5509
Mailing address
4215 DALE BLVD, WOODBRIDGE, VA 22193-2243
(571) 594-9110
(571) 526-5509
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024169586
VA
Other
Enumeration date
10/25/2016
Last updated
10/25/2016
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