Provider Demographics
NPI:1669831863
Name:MBUBIT, BLESSE
Entity Type:Individual
Prefix:
First Name:BLESSE
Middle Name:
Last Name:MBUBIT
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 1:5609 KENNEDY ST
Mailing Address - Street 2:APT. 203
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2743
Mailing Address - Country:US
Mailing Address - Phone:240-764-9537
Mailing Address - Fax:
Practice Address - Street 1:5609 KENNEDY ST
Practice Address - Street 2:APT. 203
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2743
Practice Address - Country:US
Practice Address - Phone:240-764-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11164374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide