Individual
EVA MODESTO BACONGALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1429 COLUMBIA RD NW APT 7, WASHINGTON, DC 20009-4717
(202) 699-2595
(202) 699-2595
Mailing address
1429 COLUMBIA RD NW APT 7, WASHINGTON, DC 20009-4717
(202) 699-2595
(202) 699-2595
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
A00224811
MD
Other
Enumeration date
08/28/2025
Last updated
08/28/2025
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