Provider Demographics
NPI:1053837625
Name:GHOMSI, VIVIANE
Entity Type:Individual
Prefix:
First Name:VIVIANE
Middle Name:
Last Name:GHOMSI
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 1:4826 FORT TOTTEN DR NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7556
Mailing Address - Country:US
Mailing Address - Phone:240-491-7896
Mailing Address - Fax:
Practice Address - Street 1:4826 FORT TOTTEN DR NE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7556
Practice Address - Country:US
Practice Address - Phone:240-491-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12912374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide