Healthcare Provider Details

I. General information

NPI: 1225400757
Provider Name (Legal Business Name): GIULLIANA MARIA GONZALEZ PORTILLO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 03/02/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW ATTN: MARANGELY NAZARIO
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

2333 ONTARIO RD NW ATTN: MARANGELY NAZARIO
WASHINGTON DC
20009-2627
US

V. Phone/Fax

Practice location:
  • Phone: 202-420-7175
  • Fax: 202-232-2745
Mailing address:
  • Phone: 202-420-7175
  • Fax: 202-232-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR218295
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024178826.
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1038874
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: