Dierus Tebo Fon
Case Manager/Care Coordinator in Rockville, MD. Individual provider (NPI-1).
NPI number1649007758
StatusActive
Last updated in NPPESMar 5, 2025
Details
- NPI
- 1649007758
- Entity type
- Individual (NPI-1)
- Name
- Mr. Dierus Tebo Fon
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 14, 2024
- Certification date
- Mar 5, 2025
- Last updated
- Mar 5, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171M00000X | Case Manager/Care Coordinator | – | – | Yes |
Practice location
13303 Arctic AveRockville, MD 20853-3013
Phone 240-579-5608
Mailing address
13303 Arctic AveRockville, MD 20853-3013
Phone 240-579-5608
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