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General NPI Number Information
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NPI Number | 1265895668
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Entity Type | Individual
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Provider Name | NESTOR MBORONG
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Gender | Male
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Dates
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Enumeration Date | 04/01/2016
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 7613 RIVERDALE RD APT 112
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City | NEW CARROLLTON
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State | MD
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Zip | 20784-3736
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Country | US
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Telephone | 240-714-8935
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Fax |
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Provider Business Mailing Address
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Address Line | 7613 RIVERDALE RD APT 112
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City | NEW CARROLLTON
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State | MD
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Zip | 20784-3736
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Country | US
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Telephone | 240-714-8935
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HHA11923
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN1008727
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License Number State | DC
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