Healthcare Provider Details

I. General information

NPI: 1932010741
Provider Name (Legal Business Name): DIANE BERTILLE MANTO FOKOU X
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HAMILTON ST NE APT 325
WASHINGTON DC
20011-6329
US

IV. Provider business mailing address

300 HAMILTON ST NE APT 325 325
WASHINGTON DC
20011-6329
US

V. Phone/Fax

Practice location:
  • Phone: 240-491-1696
  • Fax:
Mailing address:
  • Phone: 240-491-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: