Healthcare Provider Details

I. General information

NPI: 1417812447
Provider Name (Legal Business Name): KERT MBUYU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6708 AUBURN AVE
RIVERDALE MD
20737-1620
US

IV. Provider business mailing address

6708 AUBURN AVE
RIVERDALE MD
20737-1620
US

V. Phone/Fax

Practice location:
  • Phone: 240-498-0153
  • Fax:
Mailing address:
  • Phone: 240-498-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: