Provider Demographics
NPI:1548093370
Name:MBONGEH, LOVELINE TAYO
Entity type:Individual
Prefix:
First Name:LOVELINE
Middle Name:TAYO
Last Name:MBONGEH
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 1:416 37TH PL SE APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3219
Mailing Address - Country:US
Mailing Address - Phone:202-439-8779
Mailing Address - Fax:
Practice Address - Street 1:416 37TH PL SE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3219
Practice Address - Country:US
Practice Address - Phone:202-439-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide