Healthcare Provider Details

I. General information

NPI: 1316493554
Provider Name (Legal Business Name): MR. JULES VALEY DJOUONDA SOHKUTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14310 PLEASANT VIEW DRIVE
BOWIE MD
20720
US

IV. Provider business mailing address

14310 PLEASANT VIEW DR
BOWIE MD
20720-4809
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-8082
  • Fax:
Mailing address:
  • Phone: 240-480-8082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12322
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: