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1750050522
SOSTHENE MBALLA NDOMO
ALEXANDRIA, VA
NPI
1750050522
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Former Name
SOSTHENE NDOMO MBALLA
Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: VA 0024182625)
Enumeration Date
2021-09-07
Last Update Date
2021-09-07
Business Address
Mr. SOSTHENE MBALLA NDOMO NP
6463 ROCKSHIRE CT
ALEXANDRIA, VA 22315-3428
Phone number: 571-208-6962
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Mailing Address
Mr. SOSTHENE MBALLA NDOMO NP
6463 ROCKSHIRE CT
ALEXANDRIA, VA 22315-3428
Phone number: 571-208-6962
Copy
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