Provider Demographics
NPI:1164789129
Name:BUMBRAY, TARITA J
Entity Type:Individual
Prefix:
First Name:TARITA
Middle Name:J
Last Name:BUMBRAY
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 1:175 35TH ST NE
Mailing Address - Street 2:APT# 1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 35TH ST NE
Practice Address - Street 2:APT# 1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2524
Practice Address - Country:US
Practice Address - Phone:202-722-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide