Provider Demographics
NPI:1770358004
Name:UNOGOBI, PORTIA ANJONG
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:ANJONG
Last Name:UNOGOBI
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 1:352 N SUMMIT AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3124
Mailing Address - Country:US
Mailing Address - Phone:240-805-7421
Mailing Address - Fax:
Practice Address - Street 1:352 N SUMMIT AVE APT 103
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3124
Practice Address - Country:US
Practice Address - Phone:240-805-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN200002709164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse