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Individual
MR. SOSTHENE MBALLA NDOMO
Active
Individual
MR. SOSTHENE MBALLA NDOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0024182625
VA
363L00000X
Nurse Practitioner
0024182625
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024182625
VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS
VA
Enumeration date
09/07/2021
Last updated
02/23/2026
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