Provider Demographics
NPI:1235655192
Name:KUBONG, WAZIEH ELVIS
Entity Type:Individual
Prefix:
First Name:WAZIEH
Middle Name:ELVIS
Last Name:KUBONG
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 1:3412 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5408
Mailing Address - Country:US
Mailing Address - Phone:301-804-8343
Mailing Address - Fax:
Practice Address - Street 1:3412 HEWITT AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-5408
Practice Address - Country:US
Practice Address - Phone:301-804-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide