Provider Demographics
NPI:1730928425
Name:DEMBAGA, FATIMATA
Entity type:Individual
Prefix:
First Name:FATIMATA
Middle Name:
Last Name:DEMBAGA
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 1:1736 RHODE ISLAND AVE NE APT 207
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1785
Mailing Address - Country:US
Mailing Address - Phone:202-509-5195
Mailing Address - Fax:
Practice Address - Street 1:1736 RHODE ISLAND AVE NE APT 207
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1785
Practice Address - Country:US
Practice Address - Phone:202-509-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty