Healthcare Provider Details

I. General information

NPI: 1629837414
Provider Name (Legal Business Name): GABRIEL MBIAOH BEBONGACHEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14318 ROSETREE CT
SILVER SPRING MD
20906-1939
US

IV. Provider business mailing address

14318 ROSETREE CT
SILVER SPRING MD
20906-1939
US

V. Phone/Fax

Practice location:
  • Phone: 301-232-6363
  • Fax:
Mailing address:
  • Phone: 301-232-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: