Provider Demographics
NPI:1225459332
Name:ATEBA, APPOLINAIRE JEAN- CLAUDE SR
Entity Type:Individual
Prefix:
First Name:APPOLINAIRE
Middle Name:JEAN- CLAUDE
Last Name:ATEBA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:APPOLINAIRE
Other - Middle Name:JEAN-CLAUDE
Other - Last Name:ATEBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3025 ONTARIO RD NW
Mailing Address - Street 2:APT. B1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6044
Mailing Address - Country:US
Mailing Address - Phone:301-300-8937
Mailing Address - Fax:
Practice Address - Street 1:3025 ONTARIO RD NW
Practice Address - Street 2:APT. B1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6044
Practice Address - Country:US
Practice Address - Phone:301-300-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA7079Medicaid