Healthcare Provider Details

I. General information

NPI: 1851916522
Provider Name (Legal Business Name): MARIELY GONZALEZ MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 RICHMOND HWY STE 800
ARLINGTON VA
22202-3603
US

IV. Provider business mailing address

5021 SEMINARY RD APT 328
ALEXANDRIA VA
22311-1927
US

V. Phone/Fax

Practice location:
  • Phone: 571-257-3378
  • Fax:
Mailing address:
  • Phone: 787-662-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: