Provider Demographics
NPI:1417217019
Name:MOUTANO, MARIA A
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:MOUTANO
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 1:3435 HOLMEAD PL NW
Mailing Address - Street 2:APT 115
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3417
Mailing Address - Country:US
Mailing Address - Phone:202-906-9874
Mailing Address - Fax:
Practice Address - Street 1:3435 HOLMEAD PL NW
Practice Address - Street 2:APT 115
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3417
Practice Address - Country:US
Practice Address - Phone:202-906-9874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2639054374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide