MEDICARE: DIANA MARIA PEREZ GONZALEZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	LG200002921	DC

General Provider Information

NPI Number	:	1851129910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA MARIA PEREZ GONZALEZ

Provider Business Mailing Address
First Line	:	1 WETHERFIELD CT
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-1114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3047 15TH ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-4211
Country	:	US
Telephone Number	:	202-790-0132
Fax Number	:

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

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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Directions to “ DIANA MARIA PEREZ GONZALEZ ” Practice Location

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