Healthcare Provider Details

I. General information

NPI: 1932085677
Provider Name (Legal Business Name): STEPHEN AKENA LARUBI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COAST GUARD BLVD
PORTSMOUTH VA
23703-2199
US

IV. Provider business mailing address

4000 COAST GUARD BLVD
PORTSMOUTH VA
23703-2199
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-8740
  • Fax: 757-686-2122
Mailing address:
  • Phone: 757-483-8740
  • Fax: 757-686-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: