Healthcare Provider Details

I. General information

NPI: 1366562050
Provider Name (Legal Business Name): LUCILA ZAFRA CANETE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCILLE Z. CANETE-NELSON MD

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 FISHERS LN 5B-16
ROCKVILLE MD
20857-0001
US

IV. Provider business mailing address

10310 NEWGATE CT
ELLICOTT CITY MD
21042-5843
US

V. Phone/Fax

Practice location:
  • Phone: 301-443-1238
  • Fax: 301-443-9592
Mailing address:
  • Phone: 410-461-2749
  • Fax: 301-443-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberD0020298
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: