Provider Demographics
NPI:1972866796
Name:TONGWA, THERESA
Entity type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:
Last Name:TONGWA
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 1:5040 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:#103
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4184
Mailing Address - Country:US
Mailing Address - Phone:202-407-5023
Mailing Address - Fax:
Practice Address - Street 1:5040 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:#103
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4184
Practice Address - Country:US
Practice Address - Phone:202-407-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker