Provider Demographics
NPI:1073992632
Name:MAKOULO SOPH, CHRISTELLE MILORE
Entity Type:Individual
Prefix:
First Name:CHRISTELLE MILORE
Middle Name:
Last Name:MAKOULO SOPH
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 1:7826 EASTERN AVE NW
Mailing Address - Street 2:LL16
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1324
Mailing Address - Country:US
Mailing Address - Phone:202-723-1100
Mailing Address - Fax:
Practice Address - Street 1:7826 EASTERN AVE NW
Practice Address - Street 2:LL16
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1324
Practice Address - Country:US
Practice Address - Phone:202-723-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide