Provider Demographics
NPI:1205643871
Name:DAIGA, DESMOND FOMUNUNG
Entity type:Individual
Prefix:
First Name:DESMOND FOMUNUNG
Middle Name:
Last Name:DAIGA
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 1:9730 PASSAGE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4548
Mailing Address - Country:US
Mailing Address - Phone:206-712-3001
Mailing Address - Fax:
Practice Address - Street 1:9730 PASSAGE DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4548
Practice Address - Country:US
Practice Address - Phone:206-712-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator