Healthcare Provider Details

I. General information

NPI: 1972981298
Provider Name (Legal Business Name): MIRANDA FOZAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MARTIN LUTHER KING JR AVE SW
WASHINGTON DC
20032-4933
US

IV. Provider business mailing address

4045 WARNER AVE APT B4
LANDOVER HILLS MD
20784-1940
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-5244
  • Fax:
Mailing address:
  • Phone: 240-413-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA10632
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: