Provider Demographics
NPI:1356684344
Name:DJIBRIL, MOBARAK
Entity Type:Individual
Prefix:MR
First Name:MOBARAK
Middle Name:
Last Name:DJIBRIL
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 1:7604 HUBBLE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2521
Mailing Address - Country:US
Mailing Address - Phone:402-650-5995
Mailing Address - Fax:
Practice Address - Street 1:2501 GOOD HOPE RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3011
Practice Address - Country:US
Practice Address - Phone:402-650-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2023-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036061400Medicaid