Healthcare Provider Details

I. General information

NPI: 1174282784
Provider Name (Legal Business Name): EVANGELINE FUERTES ESCABARTE CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5816 BRADLEY BLVD
BETHESDA MD
20814-1105
US

IV. Provider business mailing address

4511 FAROE PL
ROCKVILLE MD
20853-3006
US

V. Phone/Fax

Practice location:
  • Phone: 301-219-3074
  • Fax:
Mailing address:
  • Phone: 301-915-5272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberMTOO63046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: