Provider Demographics
NPI:1376425611
Name:NAMASAKA, IMBUNDU WEKULO CHARLES (BS, CIFT, CPT)
Entity type:Individual
Prefix:
First Name:IMBUNDU
Middle Name:WEKULO CHARLES
Last Name:NAMASAKA
Suffix:
Gender:M
Credentials:BS, CIFT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 TABB CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4444
Mailing Address - Country:US
Mailing Address - Phone:202-390-0823
Mailing Address - Fax:
Practice Address - Street 1:3006 JOHN BERNARD DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2017
Practice Address - Country:US
Practice Address - Phone:415-225-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7132154225500000X
MD748773225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty