MEDICARE: DORIS DIBIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN500002645	DC

General Provider Information

NPI Number	:	1700237179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS DIBIA

Provider Business Mailing Address
First Line	:	1109 51ST STREET NE
Second Line	:	N/A
City	:	WASHINGTON
State	:	DC
Zip	:	20019-3971
Country	:	US
Telephone Number	:	202-830-5928
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 DELAWARE AVE SW APT S449
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20024-3971
Country	:	US
Telephone Number	:	202-830-5928
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	12/07/2023

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Directions to “ DORIS DIBIA ” Practice Location

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