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General NPI Number Information
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NPI Number | 1265905491
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Entity Type | Individual
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Provider Name | FORTUNATUS UGENYI
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 14440 CHERRY LANE CT STE 102B
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City | LAUREL
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State | MD
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Zip | 20707-4946
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Country | US
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Telephone | 240-646-2158
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Fax | 240-650-0860
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Provider Business Mailing Address
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Address Line | 14440 CHERRY LANE CT STE 102B
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City | LAUREL
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State | MD
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Zip | 20707-4946
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Country | US
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Telephone | 240-646-2158
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Fax | 240-650-0860
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R3743R
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License Number State | MD
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