Provider Demographics
NPI:1851054886
Name:SIBACHA, PETRA TOKOLO
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:TOKOLO
Last Name:SIBACHA
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 1:2504 10TH ST NE APT A1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1701
Mailing Address - Country:US
Mailing Address - Phone:202-509-2773
Mailing Address - Fax:
Practice Address - Street 1:2504 10TH ST NE APT A1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1701
Practice Address - Country:US
Practice Address - Phone:202-509-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program