Provider Demographics
NPI:1467982272
Name:AJONGAKAKO, BELTHA
Entity Type:Individual
Prefix:
First Name:BELTHA
Middle Name:
Last Name:AJONGAKAKO
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 1:7737 RIVERDALE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3904
Mailing Address - Country:US
Mailing Address - Phone:240-702-8668
Mailing Address - Fax:
Practice Address - Street 1:7737 RIVERDALE RD APT 304
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3904
Practice Address - Country:US
Practice Address - Phone:240-702-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12801374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide