Healthcare Provider Details

I. General information

NPI: 1205196276
Provider Name (Legal Business Name): MARGARET MUBO GBENRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 DODGE PARK RD APT 201
HYATTSVILLE MD
20785-2004
US

IV. Provider business mailing address

14524 LONDON LN
BOWIE MD
20715-2558
US

V. Phone/Fax

Practice location:
  • Phone: 202-529-6510
  • Fax:
Mailing address:
  • Phone: 202-529-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA0648
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: