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Organization
THE PROVIDENCIA GROUP
Active
Organization
THE PROVIDENCIA GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MARQUEZ (CEO)
(571) 223-4629
Entity
Organization
Contact information
Practice address
19775 BELMONT EXECUTIVE PLZ STE 450, ASHBURN, VA 20147-7606
(571) 431-1458
Mailing address
7773 WAIKAPU LOOP, HONOLULU, HI 96825-3026
(808) 282-1840
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NULL
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/14/2024
Last updated
03/14/2024
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