MEDICARE: LARISSA KOUNGA FALEU

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	376K00000X	Nurse's Aide	A00194929	MD
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1841860988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA KOUNGA FALEU

Provider Business Mailing Address
First Line	:	1301 RUPPERT RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1025
Country	:	US
Telephone Number	:	202-929-7088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 RUPPERT RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20903-1025
Country	:	US
Telephone Number	:	202-929-7088
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	12/01/2025

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