Provider Demographics
NPI:1043570476
Name:GOMBO, LIDA E (HHA)
Entity Type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:E
Last Name:GOMBO
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7826 EASTERN AVENUE, SUITE LL16, NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012
Mailing Address - Country:US
Mailing Address - Phone:202-723-1100
Mailing Address - Fax:202-723-3271
Practice Address - Street 1:17 ROCK CREEK CHURCH AVENUE, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-723-7849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide