Organization
MOBILE MEDICAL HEALTH
Active
Other names
Mobile Medical Health
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG EUSTAQUIO (PRACTICE MANAGER)
(703) 935-0330
Entity
Organization
Contact information
Practice address
44330 MERCURE CIR STE 240E, DULLES, VA 20166-2024
(703) 727-0523
Mailing address
44330 MERCURE CIR STE 240E, DULLES, VA 20166-2024
(703) 727-0523
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12196770
CAQH
—
01
—
1982640405
NPPES
VA
Enumeration date
06/29/2021
Last updated
07/08/2021
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