Healthcare Provider Details

I. General information

NPI: 1093531329
Provider Name (Legal Business Name): THIERRY MARTIAL DJOMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5346 SOUTHGATE BLVD APT 1
FAIRFIELD OH
45014-3468
US

IV. Provider business mailing address

5346 SOUTHGATE BLVD APT 1
FAIRFIELD OH
45014-3468
US

V. Phone/Fax

Practice location:
  • Phone: 513-413-0664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: