Provider Demographics
NPI:1093422982
Name:MBUALUNGU, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MBUALUNGU
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 1:14600 CEDAR KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2895
Mailing Address - Country:US
Mailing Address - Phone:571-619-3099
Mailing Address - Fax:
Practice Address - Street 1:14600 CEDAR KNOLL DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-2895
Practice Address - Country:US
Practice Address - Phone:571-619-3099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator