Healthcare Provider Details

I. General information

NPI: 1831574607
Provider Name (Legal Business Name): MONIQUE DJOUKA X
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11608 STEWART LN
SILVER SPRING MD
20904-2450
US

IV. Provider business mailing address

11608 STEWART LN
SILVER SPRING MD
20904-2450
US

V. Phone/Fax

Practice location:
  • Phone: 301-675-7550
  • Fax:
Mailing address:
  • Phone:
  • 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: