Provider Demographics
NPI:1003174681
Name:GALDAMEZ, DIANA STACEY
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:STACEY
Last Name:GALDAMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 KEOKEE ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4558
Mailing Address - Country:US
Mailing Address - Phone:301-768-2267
Mailing Address - Fax:
Practice Address - Street 1:820 UPSHUR ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5837
Practice Address - Country:US
Practice Address - Phone:202-723-0304
Practice Address - Fax:202-723-0367
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1003174681Medicaid