Healthcare Provider Details

I. General information

NPI: 1508296963
Provider Name (Legal Business Name): YAO EFIADOGBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 EASTERN AVE NW
WASHINGTON DC
20012-1324
US

IV. Provider business mailing address

7826 EASTERN AVE NW
WASHINGTON DC
20012-1324
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-7776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA9191
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: