Healthcare Provider Details

I. General information

NPI: 1780462440
Provider Name (Legal Business Name): IRENE ASSI FOMUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 RHODE ISLAND AVE NE
WASHINGTON DC
20018-1802
US

IV. Provider business mailing address

1615 RHODE ISLAND AVE NE
WASHINGTON DC
20018-1802
US

V. Phone/Fax

Practice location:
  • Phone: 240-714-1460
  • Fax:
Mailing address:
  • Phone: 202-301-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006389
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: