Individual
JUAN ILLESCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22054 SHAW RD, STE H, STERLING, VA 20164-9321
(571) 268-9858
(571) 313-1147
Mailing address
22054 SHAW RD, STE H, STERLING, VA 20164-9321
(571) 268-9858
(571) 313-1147
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
277
VA
Other
Enumeration date
05/13/2016
Last updated
05/13/2016
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