Provider Demographics
NPI:1104618834
Name:TENYA, GARIBA MBAKWA
Entity type:Individual
Prefix:
First Name:GARIBA
Middle Name:MBAKWA
Last Name:TENYA
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 1:3827 ROSEFINCH CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-1090
Mailing Address - Country:US
Mailing Address - Phone:202-446-8930
Mailing Address - Fax:
Practice Address - Street 1:3827 ROSEFINCH CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46228-1090
Practice Address - Country:US
Practice Address - Phone:202-446-8930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN431915343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)