Healthcare Provider Details

I. General information

NPI: 1629332051
Provider Name (Legal Business Name): UGO INNOCENT IGNIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 TIMBER LN
LANHAM MD
20706-2540
US

IV. Provider business mailing address

4606 TIMBER LN
LANHAM MD
20706-2540
US

V. Phone/Fax

Practice location:
  • Phone: 202-390-4681
  • Fax:
Mailing address:
  • Phone: 202-390-4681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: