Healthcare Provider Details

I. General information

NPI: 1114712916
Provider Name (Legal Business Name): DIEGO DUARTE-LEAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18605 WALKERS CHOICE RD APT 4
MONTGOMERY VILLAGE MD
20886-0546
US

IV. Provider business mailing address

18605 WALKERS CHOICE RD APT 4
MONTGOMERY VILLAGE MD
20886-0546
US

V. Phone/Fax

Practice location:
  • Phone: 240-615-5945
  • Fax:
Mailing address:
  • Phone: 240-615-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberMD10273631547
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: