MEDICARE: IMBUNDU WEKULO CHARLES NAMASAKA BS, CIFT, CPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist	7132154	WV
2	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist	748773	MD

General Provider Information

NPI Number	:	1376425611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMBUNDU WEKULO CHARLES NAMASAKA BS, CIFT, CPT

Provider Business Mailing Address
First Line	:	8603 TABB CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4444
Country	:	US
Telephone Number	:	202-390-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 JOHN BERNARD DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-2017
Country	:	US
Telephone Number	:	415-225-1260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/26/2025

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