Healthcare Provider Details

I. General information

NPI: 1164786950
Provider Name (Legal Business Name): TITA ANTHERME DJOMOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 PALMER PARK RD
HYATTSVILLE MD
20785-4145
US

IV. Provider business mailing address

7600 GEORGIA AVENUE
WASHINGTON DC
20012
US

V. Phone/Fax

Practice location:
  • Phone: 301-605-2528
  • Fax: 301-605-2528
Mailing address:
  • Phone: 202-723-3060
  • Fax: 202-723-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA6372
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: