Healthcare Provider Details

I. General information

NPI: 1619236544
Provider Name (Legal Business Name): CLAUDIA B KEHBILA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2012
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 CHILLUM RD APT # 203
MOUNT RAINIER MD
20712-1137
US

IV. Provider business mailing address

5021 TOWNSEND WAY APT C#3
BLADENSBURG MD
20710-1137
US

V. Phone/Fax

Practice location:
  • Phone: 240-330-3548
  • Fax:
Mailing address:
  • Phone: 240-330-3548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA3514
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: