Provider Demographics
NPI:1275247983
Name:TALLEY, HILDA GONZALEZ
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:GONZALEZ
Last Name:TALLEY
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 1:1001 LAWRENCE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-3513
Mailing Address - Country:US
Mailing Address - Phone:240-705-2076
Mailing Address - Fax:
Practice Address - Street 1:607 OVERHILL DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-3835
Practice Address - Country:US
Practice Address - Phone:240-705-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty