Individual
GUSTAVO NICOLAS DIAZ REVELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 OWINGS CT, SUITE 8, REISTERSTOWN, MD 21136-6428
(410) 526-7100
Mailing address
301 DUMBARTON RD, BALTIMORE, MD 21212-1533
(443) 791-8384
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MD
Other
Enumeration date
02/26/2014
Last updated
02/26/2014
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