Healthcare Provider Details

I. General information

NPI: 1588398697
Provider Name (Legal Business Name): MARIA EUGENIA GRIJALVA ZEPEDA PA-C, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

4444 CONNECTICUT AVE NW APT 707
WASHINGTON DC
20008-2320
US

V. Phone/Fax

Practice location:
  • Phone: 917-951-3229
  • Fax:
Mailing address:
  • Phone: 917-951-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberND9710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: