Provider Demographics
NPI:1457238412
Name:KEBILA, BRYAN BOBGA
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:BOBGA
Last Name:KEBILA
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 1:3711 WINDOM RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1048
Mailing Address - Country:US
Mailing Address - Phone:240-524-0637
Mailing Address - Fax:
Practice Address - Street 1:3711 WINDOM RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MD
Practice Address - Zip Code:20722-1048
Practice Address - Country:US
Practice Address - Phone:240-524-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide