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Individual
JUSTINE FOMUKONG
Active
Individual
JUSTINE FOMUKONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
017805
TX
251E00000X
Home Health Agency
Primary
017805
TX
3747P1801X
Personal Care Attendant
017805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
367886401
—
TX
Enumeration date
07/17/2015
Last updated
11/08/2021
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