MEDICARE: MARIE FLORENCE NGO MPONDI MBOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	3747P1801X	Personal Care Attendant
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1033744982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE FLORENCE NGO MPONDI MBOCK

Provider Business Mailing Address
First Line	:	3649 ELDER OAKS BLVD APT 2405
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20716-7306
Country	:	US
Telephone Number	:	240-467-1679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1845 HARVARD ST NW APT 709
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-2385
Country	:	US
Telephone Number	:	202-797-7359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	07/31/2023

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