Healthcare Provider Details

I. General information

NPI: 1487918066
Provider Name (Legal Business Name): MONDAY OKOBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7731 RIVERDALE RD APT 201
NEW CARROLLTON MD
20784-3908
US

IV. Provider business mailing address

7731 RIVERDALE RD APT 201
NEW CARROLLTON MD
20784-3908
US

V. Phone/Fax

Practice location:
  • Phone: 202-704-9047
  • Fax:
Mailing address:
  • Phone: 202-704-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: