Healthcare Provider Details

I. General information

NPI: 1164290367
Provider Name (Legal Business Name): MR. HAKEEM BUUZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7256 CALM SUNSET
COLUMBIA MD
21046-3400
US

IV. Provider business mailing address

9091 SNOWDEN RIVER PKWY # 1092
COLUMBIA MD
21046-1657
US

V. Phone/Fax

Practice location:
  • Phone: 240-549-0020
  • Fax:
Mailing address:
  • Phone: 240-549-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: