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Individual
MBONGO EMMACULATE
Active
Individual
MBONGO EMMACULATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA13296
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-524-596-015-898
ID CARD
MD
Enumeration date
12/06/2017
Last updated
06/16/2018
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