Provider Demographics
NPI:1164124582
Name:LAKO, PIERRE ELVIS
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:ELVIS
Last Name:LAKO
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 1:5120 SARGENT RD NE APT 109
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2830
Mailing Address - Country:US
Mailing Address - Phone:202-751-9001
Mailing Address - Fax:
Practice Address - Street 1:5120 SARGENT RD NE APT 109
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2830
Practice Address - Country:US
Practice Address - Phone:202-751-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3505859OtherDL