Healthcare Provider Details

I. General information

NPI: 1265972707
Provider Name (Legal Business Name): CLEMENTINE EFON TANGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 RHODE ISLAND AVE NE 2ND FLOOR
WASHINGTON DC
20018-2835
US

IV. Provider business mailing address

8507 GREENBELT RD APT T3
GREENBELT MD
20770-2306
US

V. Phone/Fax

Practice location:
  • Phone: 202-526-3535
  • Fax: 202-526-3939
Mailing address:
  • Phone: 202-640-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12664
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: