Provider Demographics
NPI:1467222398
Name:FOKOUA, PATRICE MBENKOM
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:MBENKOM
Last Name:FOKOUA
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 1:8270 MINER ST
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4401
Mailing Address - Country:US
Mailing Address - Phone:130-126-7104
Mailing Address - Fax:
Practice Address - Street 1:8270 MINER ST
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-4401
Practice Address - Country:US
Practice Address - Phone:130-126-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator