Individual
SIXTUS MBOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1418 GOOD HOPE RD SE, WASHINGTON, DC 20020-5615
(302) 898-2114
Mailing address
6933 LAMONT DR, LANHAM, MD 20706-4606
(302) 898-2114
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/13/2022
Last updated
07/26/2023
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