Provider Demographics
NPI:1023680428
Name:NTEGE, EDIMOND
Entity type:Individual
Prefix:MR
First Name:EDIMOND
Middle Name:
Last Name:NTEGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14757 SHERMAN WAY APT 216
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-5803
Mailing Address - Country:US
Mailing Address - Phone:818-448-0413
Mailing Address - Fax:
Practice Address - Street 1:14757 SHERMAN WAY APT 216
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-5803
Practice Address - Country:US
Practice Address - Phone:818-448-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver