Provider Demographics
NPI:1700630985
Name:MONYIKA, CLOVIS MOBELE
Entity Type:Individual
Prefix:
First Name:CLOVIS
Middle Name:MOBELE
Last Name:MONYIKA
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 1:4088 WARNER AVE APT B7
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1928
Mailing Address - Country:US
Mailing Address - Phone:240-564-9969
Mailing Address - Fax:
Practice Address - Street 1:4088 WARNER AVE APT B7
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1928
Practice Address - Country:US
Practice Address - Phone:240-564-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide