MEDICARE: LUZ DAMARIS PADUA-PEREZ RD, LDN

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	133V00000X	Registered Dietitian	DX3716	MD

General Provider Information

NPI Number	:	1790174746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ DAMARIS PADUA-PEREZ RD, LDN

Provider Business Mailing Address
First Line	:	2407 NORMANDY SQUARE PL
Second Line	:	APT #F
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-6133
Country	:	US
Telephone Number	:	301-807-0779
Fax Number	:

Provider Business Practice Location Address
First Line	:	2407 NORMANDY SQUARE PL
Second Line	:	APT #F
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-6133
Country	:	US
Telephone Number	:	301-807-0779
Fax Number	:

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

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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