Provider Demographics
NPI:1902604259
Name:ATABONGAFAC MAXCELUS, NGULEFAC
Entity type:Individual
Prefix:
First Name:NGULEFAC
Middle Name:
Last Name:ATABONGAFAC MAXCELUS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 85TH AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4520
Mailing Address - Country:US
Mailing Address - Phone:240-945-1739
Mailing Address - Fax:
Practice Address - Street 1:5437 85TH AVE APT 102
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4520
Practice Address - Country:US
Practice Address - Phone:240-945-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide