Healthcare Provider Details

I. General information

NPI: 1578616934
Provider Name (Legal Business Name): ELEANOR P DAQUIOAG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 NORTH CAPITAL STREET
WASHINGTON DC
20002
US

IV. Provider business mailing address

2101 EAST JEFFERSON STREET KAISER PERMANENTE, PPQA, 6 WEST, ATTN: THERESA BROOKS
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 202-898-5104
  • Fax: 202-898-5474
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD17672
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0037814
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101043235
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: