Provider Demographics
NPI:1275397283
Name:VILLOGRAM, CLIFFORD LEON
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:LEON
Last Name:VILLOGRAM
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 1:1300 SOUTHVIEW DR APT 419
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-4153
Mailing Address - Country:US
Mailing Address - Phone:202-386-0630
Mailing Address - Fax:
Practice Address - Street 1:1050 NEW JERSEY AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1317
Practice Address - Country:US
Practice Address - Phone:202-386-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant