Healthcare Provider Details

I. General information

NPI: 1376467993
Provider Name (Legal Business Name): DENIS ATAAJI ABILAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 RICHLEY CT
HYATTSVILLE MD
20784-6318
US

IV. Provider business mailing address

4110 RICHLEY CT
HYATTSVILLE MD
20784-6318
US

V. Phone/Fax

Practice location:
  • Phone: 323-996-1110
  • Fax:
Mailing address:
  • Phone: 323-996-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN200002612
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: