Provider Demographics
NPI:1518553072
Name:TEBO, FESTUS
Entity Type:Individual
Prefix:
First Name:FESTUS
Middle Name:
Last Name:TEBO
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 1:5178 EASTERN AVE NE APT 303
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2769
Mailing Address - Country:US
Mailing Address - Phone:240-898-5375
Mailing Address - Fax:
Practice Address - Street 1:5178 EASTERN AVE NE APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2769
Practice Address - Country:US
Practice Address - Phone:240-898-5375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health