Healthcare Provider Details

I. General information

NPI: 1770084162
Provider Name (Legal Business Name): CHRISTELLE DJOMO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12905 BROOKE LN
UPPER MARLBORO MD
20772-9339
US

IV. Provider business mailing address

9407 NEW HAMPSHIRE AVE
SILVER SPRING MD
20903-2316
US

V. Phone/Fax

Practice location:
  • Phone: 202-751-5167
  • Fax:
Mailing address:
  • Phone: 202-751-5167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13477
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: