Provider Demographics
NPI:1184497992
Name:DOUGLAS, DESIRE AGOBET
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:AGOBET
Last Name:DOUGLAS
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 1:8009 EASTERN AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3119
Mailing Address - Country:US
Mailing Address - Phone:202-855-4317
Mailing Address - Fax:
Practice Address - Street 1:8009 EASTERN AVE APT 202
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3119
Practice Address - Country:US
Practice Address - Phone:202-855-4317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide