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General NPI Number Information
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NPI Number | 1134477664
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Entity Type | Individual
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Provider Name | ALBERT LEGRAND SOMO DZATI
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Gender | Male
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 14304 DRIFTWOOD RD
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City | BOWIE
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State | MD
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Zip | 20721-3044
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Country | US
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Telephone | 240-260-3951
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Fax |
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Provider Business Mailing Address
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Address Line | 14304 DRIFTWOOD RD
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City | BOWIE
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State | MD
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Zip | 20721-3044
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Country | US
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Telephone | 202-904-4216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R218461
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License Number State | MD
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