Healthcare Provider Details

I. General information

NPI: 1821810532
Provider Name (Legal Business Name): JOVIAL ECHUNJEI AZOBI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10204 GALAXY VIEW LN
LANHAM MD
20706-2509
US

IV. Provider business mailing address

10204 GALAXY VIEW LN
LANHAM MD
20706-2509
US

V. Phone/Fax

Practice location:
  • Phone: 240-854-0141
  • Fax:
Mailing address:
  • Phone: 240-854-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: