Provider Demographics
NPI:1528497435
Name:NUMBUMA, EUGINE
Entity type:Individual
Prefix:
First Name:EUGINE
Middle Name:
Last Name:NUMBUMA
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 1:9102 HUNTINGTON CT
Mailing Address - Street 2:APT 203
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1002
Mailing Address - Country:US
Mailing Address - Phone:240-764-9671
Mailing Address - Fax:
Practice Address - Street 1:9102 HUNTINGTON CT
Practice Address - Street 2:APT 203
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1002
Practice Address - Country:US
Practice Address - Phone:240-764-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA8940374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide