Individual
ILIANA REVELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HHA
Contact information
Practice address
TIERNO HOME SUPPORT AGENCY, 1752 COLUMBIA ROAD, WASHINGTON DC, DC 20009
(202) 808-2365
Mailing address
627 NEWTON PL NW, WASHINGTON, DC 20010-1711
(202) 808-2365
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA200001234
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3497503
DRIVER LICENSE NUMBER
DC
Enumeration date
06/27/2022
Last updated
06/27/2022
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