Healthcare Provider Details

I. General information

NPI: 1770173627
Provider Name (Legal Business Name): FRANCES LICIA MINANO LADAGA M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date: 02/18/2022
Reactivation Date: 04/15/2024

III. Provider practice location address

4485 FORBES BLVD.
LANHAM MD
20706
US

IV. Provider business mailing address

601 EVENING STAR PL
BOWIE MD
20721
US

V. Phone/Fax

Practice location:
  • Phone: 301-429-2900
  • Fax: 443-458-7242
Mailing address:
  • Phone: 301-633-5604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number02486
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: