Healthcare Provider Details

I. General information

NPI: 1548757917
Provider Name (Legal Business Name): ZINASHWORK W MOGED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 UPSHUR ST NW # NA
WASHINGTON DC
20011-5837
US

IV. Provider business mailing address

1243 SHEPHERD ST NW # NA
WASHINGTON DC
20011-5611
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-0755
  • Fax: 202-723-0367
Mailing address:
  • Phone: 202-509-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13405
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number13405
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: