Provider Demographics
NPI:1063754513
Name:MOUMBE, JOHNSON JOSEPH (HHA)
Entity type:Individual
Prefix:MR
First Name:JOHNSON
Middle Name:JOSEPH
Last Name:MOUMBE
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11523 FEBRUARY CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6987
Mailing Address - Country:US
Mailing Address - Phone:240-398-6735
Mailing Address - Fax:240-398-5735
Practice Address - Street 1:11523 FEBRUARY CIR APT 303
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6987
Practice Address - Country:US
Practice Address - Phone:240-398-6735
Practice Address - Fax:240-398-6735
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide