Provider Demographics
NPI:1982248514
Name:MBENGA, JAINABA
Entity Type:Individual
Prefix:
First Name:JAINABA
Middle Name:
Last Name:MBENGA
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 1:413 HIDDEN BROOK DR APT L
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5444
Mailing Address - Country:US
Mailing Address - Phone:240-603-2411
Mailing Address - Fax:
Practice Address - Street 1:8609 2ND AVE STE 506B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3362
Practice Address - Country:US
Practice Address - Phone:240-398-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer