Healthcare Provider Details

I. General information

NPI: 1033033410
Provider Name (Legal Business Name): DIANE MBONGOH DAIGA JR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501, 1628 MARION BARRY AVE SE
WASHINGTON DC
20020
US

IV. Provider business mailing address

7825 MISTLETOE DR APT 266
ELKRIDGE MD
21075-7320
US

V. Phone/Fax

Practice location:
  • Phone: 202-866-7505
  • Fax: 202-866-7505
Mailing address:
  • Phone: 202-866-7505
  • Fax: 202-866-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: