Provider Demographics
NPI:1134958002
Name:LOMBO ETEKI, PAUL ALPHONSE
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALPHONSE
Last Name:LOMBO ETEKI
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 1:9510 NORDIC DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3630
Mailing Address - Country:US
Mailing Address - Phone:240-714-2844
Mailing Address - Fax:
Practice Address - Street 1:9510 NORDIC DR
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3630
Practice Address - Country:US
Practice Address - Phone:240-714-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide