Healthcare Provider Details

I. General information

NPI: 1720669427
Provider Name (Legal Business Name): RAJIV ESUA ESUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9012 CONTINENTAL PL
HYATTSVILLE MD
20785-4732
US

IV. Provider business mailing address

9012 CONTINENTAL PL
HYATTSVILLE MD
20785-4732
US

V. Phone/Fax

Practice location:
  • Phone: 202-813-7387
  • Fax:
Mailing address:
  • Phone: 202-813-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA15691
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: