Provider Demographics
NPI:1497222152
Name:ASANGONG, RELINDIS LUM
Entity Type:Individual
Prefix:
First Name:RELINDIS
Middle Name:LUM
Last Name:ASANGONG
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 1:5393 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1108
Mailing Address - Country:US
Mailing Address - Phone:240-593-7169
Mailing Address - Fax:
Practice Address - Street 1:5393 QUINCY STREET
Practice Address - Street 2:
Practice Address - City:HYATTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:240-593-7169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13777374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty