Provider Demographics
NPI:1265895668
Name:MBORONG, NESTOR
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:MBORONG
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 1:7613 RIVERDALE RD APT 112
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3736
Mailing Address - Country:US
Mailing Address - Phone:240-714-8935
Mailing Address - Fax:
Practice Address - Street 1:7613 RIVERDALE RD APT 112
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3736
Practice Address - Country:US
Practice Address - Phone:240-714-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11923374U00000X
DCLPN1008727164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty