Provider Demographics
NPI:1902211345
Name:BOHORQUEZ, LESTER (RN)
Entity Type:Individual
Prefix:
First Name:LESTER
Middle Name:
Last Name:BOHORQUEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE #1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:240-499-2636
Mailing Address - Fax:240-499-2602
Practice Address - Street 1:7620 CARROLL AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6387
Practice Address - Country:US
Practice Address - Phone:301-891-6286
Practice Address - Fax:301-891-6285
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197374163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD130061000Medicaid