Provider Demographics
NPI:1932727310
Name:PERDOMO, LILLIAN A
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:A
Last Name:PERDOMO
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 1:1820 INGLESIDE TER NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1010
Mailing Address - Country:US
Mailing Address - Phone:202-328-3194
Mailing Address - Fax:
Practice Address - Street 1:3298 FORT LINCOLN DR NE APT 304
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4306
Practice Address - Country:US
Practice Address - Phone:202-660-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant