Provider Demographics
NPI:1568283679
Name:MONGO, JULIET ENGOME
Entity type:Individual
Prefix:
First Name:JULIET
Middle Name:ENGOME
Last Name:MONGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-2007
Mailing Address - Country:US
Mailing Address - Phone:202-937-8832
Mailing Address - Fax:
Practice Address - Street 1:3415 39TH AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-2007
Practice Address - Country:US
Practice Address - Phone:202-937-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator