Provider Demographics
NPI:1518765361
Name:NDUENGA, DIDY BULUNGIDI
Entity type:Individual
Prefix:
First Name:DIDY
Middle Name:BULUNGIDI
Last Name:NDUENGA
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 1:16385 E 14TH ST APT 4202
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3244
Mailing Address - Country:US
Mailing Address - Phone:510-734-0547
Mailing Address - Fax:
Practice Address - Street 1:16385 E 14TH ST APT 4202
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3244
Practice Address - Country:US
Practice Address - Phone:510-734-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst