Provider Demographics
NPI:1467289405
Name:MONGU, SOPHINA YOMANTAP
Entity type:Individual
Prefix:
First Name:SOPHINA
Middle Name:YOMANTAP
Last Name:MONGU
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 1:4303 CRELIN PL
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1936
Mailing Address - Country:US
Mailing Address - Phone:202-591-6924
Mailing Address - Fax:
Practice Address - Street 1:4303 CRELIN PL
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1936
Practice Address - Country:US
Practice Address - Phone:202-591-6924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide