Healthcare Provider Details

I. General information

NPI: 1982568788
Provider Name (Legal Business Name): ALONZO LONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 CONDON TER SE
WASHINGTON DC
20032-3747
US

IV. Provider business mailing address

1109 SAVANNAH ST SE
WASHINGTON DC
20032-4517
US

V. Phone/Fax

Practice location:
  • Phone: 202-420-0171
  • Fax:
Mailing address:
  • Phone: 202-330-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: