Provider Demographics
NPI:1346615580
Name:YONGO, PAOLA MURIEL
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:MURIEL
Last Name:YONGO
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 1:1290 HUNTINGTON LAKE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3864
Mailing Address - Country:US
Mailing Address - Phone:240-587-7098
Mailing Address - Fax:
Practice Address - Street 1:1290 HUNTINGTON LAKE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20036-4201
Practice Address - Country:US
Practice Address - Phone:240-587-7098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-13
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11705374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide