Individual
MASOMA EBONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1818 NEW YORK AVE NE, WASHINGTON, DC 20002-1848
(202) 642-0132
Mailing address
27777 INKSTER RD, FARMINGTON HILLS, MI 48334-5310
(248) 919-1193
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
08/08/2023
Last updated
04/24/2025
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