Provider Demographics
NPI:1811799539
Name:FOMBA, BINTU
Entity type:Individual
Prefix:
First Name:BINTU
Middle Name:
Last Name:FOMBA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 RIVERDALE RD APT T1
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1047
Mailing Address - Country:US
Mailing Address - Phone:240-292-7673
Mailing Address - Fax:
Practice Address - Street 1:6840 RIVERDALE RD APT T1
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1047
Practice Address - Country:US
Practice Address - Phone:240-292-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide