MEDICARE: PIERRE ELVIS LAKO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3505859	OTHER	DC	DL

General Provider Information

NPI Number	:	1164124582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIERRE ELVIS LAKO

Provider Business Mailing Address
First Line	:	5120 SARGENT RD NE APT 109
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2830
Country	:	US
Telephone Number	:	202-751-9001
Fax Number	:

Provider Business Practice Location Address
First Line	:	5120 SARGENT RD NE APT 109
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2830
Country	:	US
Telephone Number	:	202-751-9001
Fax Number	:

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

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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Directions to “ PIERRE ELVIS LAKO ” Practice Location

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