Individual
LEEROY MBUTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6120 KANSAS AVE NE, WASHINGTON, DC 20011-1531
(202) 722-7776
Mailing address
6120 KANSAS AVE NE, WASHINGTON, DC 20011-1531
(202) 722-7776
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
HHA11230
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70822726
—
DC
Enumeration date
06/23/2015
Last updated
06/23/2015
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