MEDICARE: MR. MOGOS TECLAI RUSSOM

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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1174469530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOGOS TECLAI RUSSOM

Provider Business Mailing Address
First Line	:	225 S WHITING ST APT 404
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-7117
Country	:	US
Telephone Number	:	571-351-3940
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S WHITING ST APT 404
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-7117
Country	:	US
Telephone Number	:	571-351-3940
Fax Number	:

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

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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