Organization
KENT VILLAGE MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FEDERICO CARLOS GONZALES M.D. (OWNER)
(703) 715-9700
Entity
Organization
Contact information
Practice address
112 KENT VILLAGE SQ, MANASSAS PARK, VA 20111-4155
(703) 715-9700
(703) 715-0202
Mailing address
3700 JOSEPH SIEWICK DR, SUITE 401, FAIRFAX, VA 22033-1744
(703) 715-9700
(703) 715-0202
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
0101028651
VA
Other
Enumeration date
07/08/2014
Last updated
07/08/2014
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