Healthcare Provider Details

I. General information

NPI: 1225980824
Provider Name (Legal Business Name): MARITZA MARRERO GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 CAMPUS COMMONS DR STE 500
RESTON VA
20191-1572
US

IV. Provider business mailing address

11420 105TH AVE SW APT K10
LAKEWOOD WA
98498-6860
US

V. Phone/Fax

Practice location:
  • Phone: 888-224-6635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: