Provider Demographics
NPI:1174026306
Name:MODIKA, VIOLET MABOTA
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:MABOTA
Last Name:MODIKA
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 1:1808 METZEROTT RD APT 54
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-5125
Mailing Address - Country:US
Mailing Address - Phone:202-492-0139
Mailing Address - Fax:
Practice Address - Street 1:1808 METZEROTT RD APT 54
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-5125
Practice Address - Country:US
Practice Address - Phone:202-492-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13527374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide