Healthcare Provider Details

I. General information

NPI: 1558138776
Provider Name (Legal Business Name): LIONNEL SIMO GUEGUEM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 85TH AVE APT 12
NEW CARROLLTON MD
20784-3225
US

IV. Provider business mailing address

5311 85TH AVE APT 12
NEW CARROLLTON MD
20784-3225
US

V. Phone/Fax

Practice location:
  • Phone: 202-381-6006
  • Fax:
Mailing address:
  • Phone: 202-381-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: