Organization
OLD TOWN MANASSAS MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FLAVIANO DAZO D.N.P., FNP-BC (OWNER)
(703) 365-0397
Entity
Organization
Contact information
Practice address
9003 CHURCH ST, MANASSAS, VA 20110-5410
(703) 365-0397
(703) 365-0399
Mailing address
9003 CHURCH ST, MANASSAS, VA 20110-5410
(703) 365-0397
(703) 365-0399
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0663198-0
VA
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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