Provider Demographics
NPI:1841860988
Name:FALEU, LARISSA KOUNGA
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:KOUNGA
Last Name:FALEU
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 1:1301 RUPPERT RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-1025
Mailing Address - Country:US
Mailing Address - Phone:202-929-7088
Mailing Address - Fax:
Practice Address - Street 1:1301 RUPPERT RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-1025
Practice Address - Country:US
Practice Address - Phone:202-929-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00194929376K00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No376K00000XNursing Service Related ProvidersNurse's Aide