DIVINE HEALTH MEDICAL AND SPA LLC NPI 1790428555

NPI Information

NPI: 1790428555
Provider Name: DIVINE HEALTH MEDICAL AND SPA LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 21D2265145

Address:
11119 ROCKVILLE PIKE STE 320
ROCKVILLE, MD
ZIP 20852
Phone: (240) 669-6598
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DIVINE HEALTH MEDICAL AND SPA LLC is a primary care clinic center in Rockville, MD. DIVINE HEALTH MEDICAL AND SPA LLC NPI is 1790428555. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

11119 ROCKVILLE PIKE STE 320
ROCKVILLE, MD
ZIP 20852-143
Phone: (240) 669-6598
Fax: (240) 669-6079

The provider's authorized official is Sally Owie Young .
The authorized official title is Educator and has the following contact phone number (240) 437-9997.

The CLIA number assigned to this NPI record is 21D2265145 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/19/2022 and was last updated on 7/14/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			No
2	261QP2300X	Clinic/Center	Primary Care			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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