Provider Demographics
NPI:1104635598
Name:MISSE NDOCKO, ALEXIS ALFRED
Entity type:Individual
Prefix:
First Name:ALEXIS ALFRED
Middle Name:
Last Name:MISSE NDOCKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 MAPLE AVE APT 902
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5552
Mailing Address - Country:US
Mailing Address - Phone:786-645-9399
Mailing Address - Fax:
Practice Address - Street 1:7600 MAPLE AVE APT 902
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5552
Practice Address - Country:US
Practice Address - Phone:786-645-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker