Healthcare Provider Details

I. General information

NPI: 1265271142
Provider Name (Legal Business Name): ONYINYECHI DESTINY AGUBUZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ONYINYECHI DESTINY AGUBUZO

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 ANNAPOLIS RD
BOWIE MD
20720-3809
US

IV. Provider business mailing address

11010 ANNAPOLIS RD
BOWIE MD
20720-3809
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-9090
  • Fax:
Mailing address:
  • Phone: 240-447-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRSA-02395
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberRSA-02395
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: