Provider Demographics
NPI:1598444226
Name:BABILA, MATILDER MBONGHO
Entity Type:Individual
Prefix:
First Name:MATILDER
Middle Name:MBONGHO
Last Name:BABILA
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 1:9111 CONTEE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2112
Mailing Address - Country:US
Mailing Address - Phone:240-278-1659
Mailing Address - Fax:
Practice Address - Street 1:9111 CONTEE RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2112
Practice Address - Country:US
Practice Address - Phone:240-278-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003060374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide