Provider Demographics
NPI:1134613599
Name:MBENGWA, ZUHURA
Entity type:Individual
Prefix:
First Name:ZUHURA
Middle Name:
Last Name:MBENGWA
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 1:8335 SUMMA AVE APT A2
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3657
Mailing Address - Country:US
Mailing Address - Phone:225-831-1766
Mailing Address - Fax:225-831-1766
Practice Address - Street 1:9150 BEREFORD DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2403
Practice Address - Country:US
Practice Address - Phone:225-960-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician