MEDICARE: DOMINIQUE NGONGBA NGOUADAKPA

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1699227579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE NGONGBA NGOUADAKPA

Provider Business Mailing Address
First Line	:	7826 EASTERN AVENUE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7826 EASTERN AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-1324
Country	:	US
Telephone Number	:	202-723-7011
Fax Number	:

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

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	01/20/2017

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