Provider Demographics
NPI:1922830645
Name:PFINGU, ROGER SAMBU
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:SAMBU
Last Name:PFINGU
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 1:4183 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3791
Mailing Address - Country:US
Mailing Address - Phone:513-400-2079
Mailing Address - Fax:
Practice Address - Street 1:4183 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45011-3791
Practice Address - Country:US
Practice Address - Phone:513-400-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVB6047513747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant