Provider Demographics
NPI:1528702727
Name:MUASYA, JUDAH MWONGELA
Entity type:Individual
Prefix:MR
First Name:JUDAH
Middle Name:MWONGELA
Last Name:MUASYA
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 1:8017 GEORGE FOX PL
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2347
Mailing Address - Country:US
Mailing Address - Phone:202-629-6909
Mailing Address - Fax:
Practice Address - Street 1:9020F LORTON STATION BLVD STE 119
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4799
Practice Address - Country:US
Practice Address - Phone:703-554-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care