Organization
HISPANIC AMERICAN PEDIATRIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEMAL OMIDVAR M.D (PRESIDENT)
(703) 751-2021
Entity
Organization
Contact information
Practice address
5130 DUKE STREET, SUITE 7, ALEXANDRIA, VA 22304-7207
(703) 751-2021
(703) 751-2071
Mailing address
5130 DUKE ST STE 7, SUITE 229, ALEXANDRIA, VA 22304-2955
(703) 751-2021
(703) 751-2071
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
40990-01
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002632800
—
MD
05
—
010117534
—
VA
05
—
010125561
—
VA
Enumeration date
11/22/2006
Last updated
01/30/2017
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