MEDICARE: RAISA BETANGA MBOHWOH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1134937105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAISA BETANGA MBOHWOH

Provider Business Mailing Address
First Line	:	11238 HANNAH WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1681
Country	:	US
Telephone Number	:	865-309-3517
Fax Number	:

Provider Business Practice Location Address
First Line	:	11238 HANNAH WAY
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-1681
Country	:	US
Telephone Number	:	865-309-3517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	12/23/2024

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Directions to “ RAISA BETANGA MBOHWOH ” Practice Location

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