Provider Demographics
NPI:1407625353
Name:TENGEB, VICTORINE AGHA
Entity Type:Individual
Prefix:
First Name:VICTORINE AGHA
Middle Name:
Last Name:TENGEB
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 1:3320 DODGE PARK RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2116
Mailing Address - Country:US
Mailing Address - Phone:240-886-4142
Mailing Address - Fax:
Practice Address - Street 1:3320 DODGE PARK RD APT 101
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2116
Practice Address - Country:US
Practice Address - Phone:240-886-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide