Provider Demographics
NPI:1033582150
Name:DJOMO, JULES ISAAC
Entity Type:Individual
Prefix:
First Name:JULES
Middle Name:ISAAC
Last Name:DJOMO
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 1:8629 ANNAPOLIS RD
Mailing Address - Street 2:APT 202
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3109
Mailing Address - Country:US
Mailing Address - Phone:612-806-3484
Mailing Address - Fax:
Practice Address - Street 1:8629 ANNAPOLIS RD
Practice Address - Street 2:APT 202
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3109
Practice Address - Country:US
Practice Address - Phone:612-806-3484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11638374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide