Healthcare Provider Details

I. General information

NPI: 1265364830
Provider Name (Legal Business Name): JUTO NDONFACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 LENFANT SQ SE
WASHINGTON DC
20020-6724
US

IV. Provider business mailing address

14219 GREENVIEW DR
LAUREL MD
20708-3215
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-3685
  • Fax:
Mailing address:
  • Phone: 240-413-3685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: