Healthcare Provider Details

I. General information

NPI: 1760140719
Provider Name (Legal Business Name): ABISOLA GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 MERRILL LN APT 201
LAUREL MD
20708-2028
US

IV. Provider business mailing address

8905 MERRILL LN APT 201
LAUREL MD
20708-2028
US

V. Phone/Fax

Practice location:
  • Phone: 202-290-6923
  • Fax:
Mailing address:
  • Phone: 202-290-6923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200002106
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00160325
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: