Healthcare Provider Details

I. General information

NPI: 1245632397
Provider Name (Legal Business Name): MARIA MILAGROS HEPLER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA MILAGROS HEPLER RD

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 BELLEVIEW AVE
CHEVERLY MD
20785-1228
US

IV. Provider business mailing address

3312 BELLEVIEW AVE
CHEVERLY MD
20785-1228
US

V. Phone/Fax

Practice location:
  • Phone: 814-460-0487
  • Fax:
Mailing address:
  • Phone: 814-460-0487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number966663
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: