Provider Demographics
NPI:1619652013
Name:BALDONADO DE MARMOL, MARIA FELICIA
Entity Type:Individual
Prefix:MRS
First Name:MARIA FELICIA
Middle Name:
Last Name:BALDONADO DE MARMOL
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 1:410 CEDAR ST NW # 11NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1951
Mailing Address - Country:US
Mailing Address - Phone:202-250-9631
Mailing Address - Fax:
Practice Address - Street 1:5728 OREGON AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1143
Practice Address - Country:US
Practice Address - Phone:202-460-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ACTIVE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant