Healthcare Provider Details

I. General information

NPI: 1871828806
Provider Name (Legal Business Name): LAYNE KATHRYN DILORETO AA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2104
US

IV. Provider business mailing address

1150 VARNUM ST NE
WASHINGTON DC
20017-2104
US

V. Phone/Fax

Practice location:
  • Phone: 202-448-4041
  • Fax:
Mailing address:
  • Phone: 202-448-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA000023
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: