Provider Demographics
NPI:1386208064
Name:AJALA, AUGUSTINE
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:
Last Name:AJALA
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 1:13408 COLDWATER DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5428
Mailing Address - Country:US
Mailing Address - Phone:443-204-4065
Mailing Address - Fax:
Practice Address - Street 1:3348 BLAINE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1327
Practice Address - Country:US
Practice Address - Phone:202-399-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-27
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide