Provider Demographics
NPI:1760194211
Name:AJOSE, BEGONIA
Entity Type:Individual
Prefix:
First Name:BEGONIA
Middle Name:
Last Name:AJOSE
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 1:221 E DIXIE CT APT 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-9028
Mailing Address - Country:US
Mailing Address - Phone:754-367-6256
Mailing Address - Fax:
Practice Address - Street 1:221 E DIXIE CT APT 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-9028
Practice Address - Country:US
Practice Address - Phone:754-367-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health