Individual
BETOTO WALTA DIANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3542 DEAN DR APT G4, HYATTSVILLE, MD 20782-1213
(240) 701-8549
Mailing address
3542 DEAN DR APT G4, HYATTSVILLE, MD 20782-1213
(240) 701-8549
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
D-520085866278
MD
Other
Enumeration date
05/30/2012
Last updated
05/30/2012
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