Healthcare Provider Details

I. General information

NPI: 1588637656
Provider Name (Legal Business Name): MILAGROS COMPLETO GONZALEZ M.ED., R.D., L.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2180
US

IV. Provider business mailing address

20575A SHADYSIDE WAY
GERMANTOWN MD
20874-2830
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-7155
  • Fax: 202-269-7316
Mailing address:
  • Phone: 301-515-7395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD1575
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD01578
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: