Healthcare Provider Details

I. General information

NPI: 1770914558
Provider Name (Legal Business Name): CECILE NJOUMKAM ZO OBO ANGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 EDGEWOOD ST NE APT 4
WASHINGTON DC
20017-3305
US

IV. Provider business mailing address

415 EDGEWOOD ST NE APT 4
WASHINGTON DC
20017-3305
US

V. Phone/Fax

Practice location:
  • Phone: 202-239-7004
  • Fax:
Mailing address:
  • Phone: 202-239-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number8314
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: