Provider Demographics
NPI:1326569971
Name:BOBGA ESPE SONE KOME, YESIA N
Entity Type:Individual
Prefix:
First Name:YESIA
Middle Name:N
Last Name:BOBGA ESPE SONE KOME
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 1:3813 64TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1848
Mailing Address - Country:US
Mailing Address - Phone:575-495-6454
Mailing Address - Fax:
Practice Address - Street 1:1220 12TH ST SE STE G35
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:202-544-8090
Practice Address - Fax:202-544-8090
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12462374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide