Provider Demographics
NPI:1649530767
Name:BENGA, RUPHINE
Entity type:Individual
Prefix:
First Name:RUPHINE
Middle Name:
Last Name:BENGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9795 GOOD LUCK RD
Mailing Address - Street 2:#17
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3346
Mailing Address - Country:US
Mailing Address - Phone:240-476-8631
Mailing Address - Fax:
Practice Address - Street 1:9795 GOOD LUCK RD
Practice Address - Street 2:#17
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:240-476-8631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA0049374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide