Provider Demographics
NPI:1881063246
Name:TOMBOYEKE, FATMATA BABY DABOH
Entity type:Individual
Prefix:
First Name:FATMATA
Middle Name:BABY DABOH
Last Name:TOMBOYEKE
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 1:790 FAIRVIEW AVE APT 312
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-5957
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 MASSCHUSETTS AVE NW SUIT
Practice Address - Street 2:WHOLISTIC HOME SERVICES
Practice Address - City:WASHINGTON DC
Practice Address - State:DC
Practice Address - Zip Code:20005
Practice Address - Country:US
Practice Address - Phone:202-560-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA8848374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide