Provider Demographics
NPI:1457714594
Name:NOUBEG, CECILE NGUEBON
Entity Type:Individual
Prefix:
First Name:CECILE
Middle Name:NGUEBON
Last Name:NOUBEG
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 1:1505 HAMPSHIRE WEST CT APT 7
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2536
Mailing Address - Country:US
Mailing Address - Phone:240-705-1916
Mailing Address - Fax:
Practice Address - Street 1:1505 HAMPSHIRE WEST CT APT 7
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2536
Practice Address - Country:US
Practice Address - Phone:240-705-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11921374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD56221732OtherKAISER PERMANENTE , MEDICAL RECORD NUMBER