Organization
GUADALUPE FREE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL MULDOON MD (MEDICAL DIRECTOR)
(540) 840-9002
Entity
Organization
Contact information
Practice address
700 MCKINNEY BLVD STE 1100, COLONIAL BEACH, VA 22443-1934
(804) 224-0571
(804) 224-0572
Mailing address
700 MCKINNEY BLVD STE 1100, COLONIAL BEACH, VA 22443-1934
(804) 224-0571
(804) 224-0572
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0201004142
VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS, BOARD OF PHARMACY
VA
01
—
C65
VIRGINIA IMMUNIZATION INFORMATION SYSTEM
VA
Enumeration date
10/23/2024
Last updated
10/23/2024
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