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NPI Code Detail

MEDICARE: BOBBY BONGAM

MEDICARE: BOBBY BONGAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2374U00000XHome Health Aide
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1558761593
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOBBY BONGAM
Provider Business Mailing Address
First Line : 2934 VISTA ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-2636
Country : US
Telephone Number : 202-423-5599
Fax Number :
Provider Business Practice Location Address
First Line : 2934 VISTA ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-2636
Country : US
Telephone Number : 202-423-5599
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2014
Last Update Date : 02/26/2025

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Directions to “ BOBBY BONGAM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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