Provider Demographics
NPI:1396106290
Name:JALLOH, RUGIATU
Entity type:Individual
Prefix:
First Name:RUGIATU
Middle Name:
Last Name:JALLOH
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 1:9865 GOOD LUCK RD APT 10
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3226
Mailing Address - Country:US
Mailing Address - Phone:202-718-6575
Mailing Address - Fax:
Practice Address - Street 1:9865 GOOD LUCK RD APT 10
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3226
Practice Address - Country:US
Practice Address - Phone:202-718-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC9240374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide