Provider Demographics
NPI:1477014843
Name:MORILLO, MIRIAM ALTAGRACIA
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ALTAGRACIA
Last Name:MORILLO
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 1:6105 RAY CT
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-5026
Mailing Address - Country:US
Mailing Address - Phone:240-418-2019
Mailing Address - Fax:
Practice Address - Street 1:1719 EVARTS ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2029
Practice Address - Country:US
Practice Address - Phone:202-213-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant