Provider Demographics
NPI:1841718392
Name:DIBAKI, NGONJE EMILIA
Entity type:Individual
Prefix:
First Name:NGONJE
Middle Name:EMILIA
Last Name:DIBAKI
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 1:7900 STABLE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-2579
Mailing Address - Country:US
Mailing Address - Phone:651-500-7135
Mailing Address - Fax:
Practice Address - Street 1:7900 STABLE GLEN DRIVE
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025
Practice Address - Country:US
Practice Address - Phone:651-500-7135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker