Healthcare Provider Details

I. General information

NPI: 1003645276
Provider Name (Legal Business Name): MR. PAUL EYONG EMMANUEL MBONGEYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 MARTIN LUTHER KING JR AVE SE STE 301
WASHINGTON DC
20032-2651
US

IV. Provider business mailing address

9200 ISPAHAN LOOP
LAUREL MD
20708-2866
US

V. Phone/Fax

Practice location:
  • Phone: 240-374-2116
  • Fax:
Mailing address:
  • Phone: 240-374-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: