Provider Demographics
NPI:1689081556
Name:TEZOCK, BLASIUS EYONG
Entity Type:Individual
Prefix:
First Name:BLASIUS
Middle Name:EYONG
Last Name:TEZOCK
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 1:4201 EASTERN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1401
Mailing Address - Country:US
Mailing Address - Phone:202-569-0010
Mailing Address - Fax:
Practice Address - Street 1:4201 EASTERN AVE APT 1
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1401
Practice Address - Country:US
Practice Address - Phone:202-569-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-12
Last Update Date:2014-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10466374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide