Healthcare Provider Details

I. General information

NPI: 1902166325
Provider Name (Legal Business Name): DIDEROT BIBILA SAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8830 PINEY BRANCH RD APT 1101
SILVER SPRING MD
20903
US

IV. Provider business mailing address

8830 PINEY BRANCH RD APT 1101
SILVER SPRING MD
20903
US

V. Phone/Fax

Practice location:
  • Phone: 240-603-9411
  • Fax:
Mailing address:
  • Phone: 240-603-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: