Healthcare Provider Details

I. General information

NPI: 1104513340
Provider Name (Legal Business Name): EMMANUEL GUSUA GABILA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 AYNOR DR
BOWIE MD
20721-2442
US

IV. Provider business mailing address

3704 AYNOR DR
BOWIE MD
20721-2442
US

V. Phone/Fax

Practice location:
  • Phone: 240-547-7959
  • Fax:
Mailing address:
  • Phone: 240-547-7959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: