Provider Demographics
NPI:1760104863
Name:ONDOUA, JEAN SYLVAIN ATEBA
Entity Type:Individual
Prefix:MR
First Name:JEAN SYLVAIN
Middle Name:ATEBA
Last Name:ONDOUA
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 1:9229 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-2451
Mailing Address - Country:US
Mailing Address - Phone:240-423-4691
Mailing Address - Fax:443-773-1367
Practice Address - Street 1:9229 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-2451
Practice Address - Country:US
Practice Address - Phone:240-423-4691
Practice Address - Fax:443-773-1367
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3567320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities