Healthcare Provider Details

I. General information

NPI: 1265972533
Provider Name (Legal Business Name): GEREMIAS LUZON CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 BUNKER HILL RD NE
WASHINGTON DC
20017-3026
US

IV. Provider business mailing address

3404 NICHOLSON ST
HYATTSVILLE MD
20782-3172
US

V. Phone/Fax

Practice location:
  • Phone: 202-635-5756
  • Fax: 202-635-5780
Mailing address:
  • Phone: 301-559-0461
  • Fax: 202-635-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA000101014
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: