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NPI Code Detail

MEDICARE: TIFUH MBAYI GANA

MEDICARE: TIFUH MBAYI GANA
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
1374U00000XHome Health Aide

General Provider Information

NPI Number : 1790043875
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFUH MBAYI GANA
Provider Business Mailing Address
First Line : 11224 EVANS TRL APT 202
Second Line :
City : BELTSVILLE
State : MD
Zip : 20705-3915
Country : US
Telephone Number : 240-393-7683
Fax Number :
Provider Business Practice Location Address
First Line : 2312 RHODE ISLAND AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20018-2829
Country : US
Telephone Number : 202-635-6006
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2012
Last Update Date : 04/26/2012

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Directions to “ TIFUH MBAYI GANA ” Practice Location

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