Provider Demographics
NPI:1447060579
Name:MBAKWA, RICHMON TEKOM
Entity type:Individual
Prefix:
First Name:RICHMON
Middle Name:TEKOM
Last Name:MBAKWA
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 1:12416 ROCHINO CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9047
Mailing Address - Country:US
Mailing Address - Phone:202-981-8842
Mailing Address - Fax:
Practice Address - Street 1:12416 ROCHINO CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9047
Practice Address - Country:US
Practice Address - Phone:202-981-8842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide