Provider Demographics
NPI:1073373544
Name:BIBBS, DAIJON
Entity Type:Individual
Prefix:
First Name:DAIJON
Middle Name:
Last Name:BIBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 OLD FORGE LN APT 4202
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2983
Mailing Address - Country:US
Mailing Address - Phone:202-423-9410
Mailing Address - Fax:
Practice Address - Street 1:320 OLD FORGE LN APT 4202
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2983
Practice Address - Country:US
Practice Address - Phone:202-423-9410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator