Healthcare Provider Details

I. General information

NPI: 1205228269
Provider Name (Legal Business Name): CHONTIE LETRISHA TABRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6031 KANSAS AVE NW UNIT 201
WASHINGTON DC
20011-1566
US

IV. Provider business mailing address

6031 KANSAS AVE NW UNIT 201
WASHINGTON DC
20011-1566
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-5040
  • Fax: 202-545-5043
Mailing address:
  • Phone: 202-545-5040
  • Fax: 202-545-5043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA9476
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: