Healthcare Provider Details

I. General information

NPI: 1548649064
Provider Name (Legal Business Name): MISS CELINE DJOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 23RD ST NW
WASHINGTON DC
20037-1456
US

IV. Provider business mailing address

1010 23RD ST NW
WASHINGTON DC
20037-1456
US

V. Phone/Fax

Practice location:
  • Phone: 240-774-0912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberHHA9847
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: