Provider Demographics
NPI:1154817526
Name:MAPONGA, RODRECK
Entity Type:Individual
Prefix:MR
First Name:RODRECK
Middle Name:
Last Name:MAPONGA
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 1:5055 PEAR RIDGE DR APT 1428
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-3127
Mailing Address - Country:US
Mailing Address - Phone:214-414-4451
Mailing Address - Fax:
Practice Address - Street 1:101 E PARK BLVD STE 600
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8818
Practice Address - Country:US
Practice Address - Phone:214-414-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide