Provider Demographics
NPI:1447798244
Name:GBOYA, ISATA
Entity Type:Individual
Prefix:
First Name:ISATA
Middle Name:
Last Name:GBOYA
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 1:6825D RIVERDALE RD
Mailing Address - Street 2:RIVERADLE APT 202 D
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1839
Mailing Address - Country:US
Mailing Address - Phone:240-383-7333
Mailing Address - Fax:
Practice Address - Street 1:6825D RIVERDALE RD
Practice Address - Street 2:RIVERADLE APT 202 D
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1839
Practice Address - Country:US
Practice Address - Phone:240-383-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide