Healthcare Provider Details

I. General information

NPI: 1386558682
Provider Name (Legal Business Name): EMMANUEL SOBOWALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 1ST ST NE STE 425
WASHINGTON DC
20002-9115
US

IV. Provider business mailing address

7184 STONE THROW WAY
ELKRIDGE MD
21075-7909
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-1209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006878
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: