Active NPI
Gabriela Perdomo, PA-C
- Physician Assistant
- Oxon Hill, MD
National Provider Identifier
1114440922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- C06484
- Practice address
- 174 Waterfront St Ste 200
Oxon Hill, MD 20745-1164 - Phone
- (000) 000-0000
- NPI assigned
- Jul 24, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | C06484 | MD | Primary |
Addresses
Primary practice location
174 Waterfront St Ste 200
Oxon Hill, MD 20745-1164
Mailing address
151 Southhall LN Ste 300
Maitland, FL 32751-7172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1500854400000",
"number": "1114440922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "151 SOUTHHALL LN STE 300",
"city": "MAITLAND",
"state": "FL",
"postal_code": "327517172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "174 WATERFRONT ST STE 200",
"city": "OXON HILL",
"state": "MD",
"postal_code": "207451164",
"telephone_number": "000-000-0000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERDOMO",
"first_name": "GABRIELA",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-24",
"last_updated": "2017-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MD",
"license": "C06484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oxon Hill, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.