MEDICARE: LUZ VIVIANA DE JESUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	172V00000X	Community Health Worker
2	174H00000X	Health Educator
3	374J00000X	Doula

General Provider Information

NPI Number	:	1336648724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ VIVIANA DE JESUS

Provider Business Mailing Address
First Line	:	2445 15TH ST NW APT 211
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-4112
Country	:	US
Telephone Number	:	202-425-7375
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 15TH ST NW APT 211
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-4112
Country	:	US
Telephone Number	:	202-425-7375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	11/09/2021

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