Individual
DESTAING OGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4203 55TH AVE, BLADENSBURG, MD 20710-1507
(202) 545-0935
(202) 545-0934
Mailing address
4203 55TH AVE, BLADENSBURG, MD 20710-1507
(202) 545-0935
(202) 545-0934
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
09/21/2012
Last updated
02/23/2024
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