Provider Demographics
NPI:1033896394
Name:MBARGA, LUCAS ESSOMBA
Entity Type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:ESSOMBA
Last Name:MBARGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 WILLOWWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4081
Mailing Address - Country:US
Mailing Address - Phone:786-612-7783
Mailing Address - Fax:
Practice Address - Street 1:1616 WILLOWWOOD CT
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4081
Practice Address - Country:US
Practice Address - Phone:786-612-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15283374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide