Healthcare Provider Details

I. General information

NPI: 1386346096
Provider Name (Legal Business Name): MR. PRINCE MBECHA TAZOCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 HARDWOOD DR
LANHAM MD
20706-2858
US

IV. Provider business mailing address

6301 HARDWOOD DR
LANHAM MD
20706-2858
US

V. Phone/Fax

Practice location:
  • Phone: 240-886-6145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200003427
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: