Organization
ESSENTIALS SOULON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEJUAN ANDREA BURNS (OWNER)
(202) 802-3098
Entity
Organization
Contact information
Practice address
2736 KEATING ST, TEMPLE HILLS, MD 20748-1512
(202) 802-3098
(301) 836-1772
Mailing address
6600 HORSESHOE RD, CLINTON, MD 20735-2537
(202) 802-3098
(301) 836-1772
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013275445
1174998009
MD
Enumeration date
12/03/2015
Last updated
12/03/2015
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