Provider Demographics
NPI:1205401692
Name:RAYMUNDO, LUZ
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:
Last Name:RAYMUNDO
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 1:14 TUCKERMAN ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1418
Mailing Address - Country:US
Mailing Address - Phone:202-510-6199
Mailing Address - Fax:
Practice Address - Street 1:3446 CONNECTICUT AVE NW APT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1313
Practice Address - Country:US
Practice Address - Phone:202-362-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant