Provider Demographics
NPI:1982151056
Name:MASENO, JAMES (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MASENO
Suffix:
Gender:M
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 LANDOVER RD
Mailing Address - Street 2:APT. T2
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1337
Mailing Address - Country:US
Mailing Address - Phone:240-595-9209
Mailing Address - Fax:
Practice Address - Street 1:6337 LANDOVER RD
Practice Address - Street 2:APT. T2
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1337
Practice Address - Country:US
Practice Address - Phone:240-595-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12252374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide