Individual
LARISSA JUNIL KEMGNE BOUGEKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1912 FOX ST APT 104, ADELPHI, MD 20783-2362
(240) 224-1359
Mailing address
1912 FOX ST APT 104, ADELPHI, MD 20783-2362
(240) 224-1359
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA13192
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HHA13192
—
DC
Enumeration date
04/03/2018
Last updated
04/03/2018
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