Provider Demographics
NPI:1619312600
Name:NGALA, NGANGE
Entity Type:Individual
Prefix:
First Name:NGANGE
Middle Name:
Last Name:NGALA
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 1:9107 WALLACE RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4213
Mailing Address - Country:US
Mailing Address - Phone:240-462-3330
Mailing Address - Fax:
Practice Address - Street 1:9107 WALLACE RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4213
Practice Address - Country:US
Practice Address - Phone:240-462-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA5519374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide