Provider Demographics
NPI:1699341859
Name:NUEVA VITA LLC
Entity type:Organization
Organization Name:NUEVA VITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-626-5230
Mailing Address - Street 1:2415 MUSGROVE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5202
Mailing Address - Country:US
Mailing Address - Phone:301-337-2295
Mailing Address - Fax:301-809-1752
Practice Address - Street 1:2415 MUSGROVE RD STE 302
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5202
Practice Address - Country:US
Practice Address - Phone:301-337-2295
Practice Address - Fax:301-804-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty