Provider Demographics
NPI:1417584012
Name:MINGO, DIAMOND JASMINE
Entity Type:Individual
Prefix:
First Name:DIAMOND
Middle Name:JASMINE
Last Name:MINGO
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 1:4223 E CAPITOL ST SE APT 20
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4478
Mailing Address - Country:US
Mailing Address - Phone:301-549-8168
Mailing Address - Fax:
Practice Address - Street 1:896 SOUTHERN AVE SE APT 206
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3454
Practice Address - Country:US
Practice Address - Phone:202-563-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion