Provider Demographics
NPI:1962370247
Name:FOBASSO, LILIANE
Entity type:Individual
Prefix:
First Name:LILIANE
Middle Name:
Last Name:FOBASSO
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 1:9562 NATURE TRL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3173
Mailing Address - Country:US
Mailing Address - Phone:240-645-3825
Mailing Address - Fax:
Practice Address - Street 1:9562 NATURE TRL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3173
Practice Address - Country:US
Practice Address - Phone:240-645-3825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200005634374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide