Healthcare Provider Details

I. General information

NPI: 1447116363
Provider Name (Legal Business Name): MARVIN DIAZ-LEMUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12105 DARNESTOWN RD STE L-8
GAITHERSBURG MD
20878-2217
US

IV. Provider business mailing address

12105 DARNESTOWN RD STE L-8
GAITHERSBURG MD
20878-2217
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-0006
  • Fax:
Mailing address:
  • Phone: 301-869-0006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS04281
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: