Healthcare Provider Details

I. General information

NPI: 1285557736
Provider Name (Legal Business Name): JOSPH ANU FONDENGCUP NDEMALIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 23RD PL
TEMPLE HILLS MD
20748-3213
US

IV. Provider business mailing address

4411 23RD PL
TEMPLE HILLS MD
20748-3213
US

V. Phone/Fax

Practice location:
  • Phone: 301-433-1592
  • Fax:
Mailing address:
  • Phone: 301-433-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006432
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: