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General NPI Number Information
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NPI Number | 1376425611
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Entity Type | Individual
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Provider Name | IMBUNDU WEKULO CHARLES NAMASAKA BS, CIFT, CPT
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Gender | Male
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Dates
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Enumeration Date | 07/25/2025
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Last Update Date | 07/26/2025
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Provider Practice Location Address
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Address Line | 3006 JOHN BERNARD DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2017
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Country | US
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Telephone | 415-225-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 8603 TABB CT
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City | BOWIE
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State | MD
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Zip | 20720-4444
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Country | US
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Telephone | 202-390-0823
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number | 7132154
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225500000X
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Taxonomy Name | Respiratory/Developmental/Rehabilitative Specialist/Technologist
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License Number | 748773
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License Number State | MD
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