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General NPI Number Information
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NPI Number | 1508996489
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Entity Type | Individual
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Provider Name | COMFORT FOMBU
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2083 DORCHESTER AVENUE APT. #3
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City | DORCHESTER CENTER
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State | MA
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Zip | 02124-4795
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Country | US
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Telephone | 617-298-6949
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Fax | 617-298-6949
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Provider Business Mailing Address
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Address Line | 2083 DORCHESTER AVE APT. #3
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City | DORCHESTER CENTER
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State | MA
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Zip | 02124-4795
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Country | US
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Telephone | 617-298-6949
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Fax | 617-298-6949
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 262119
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License Number State | MA
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