1538854187 NPI number — ROY ABUANGEON AMBOMU

Table of content: ROY ABUANGEON AMBOMU (NPI 1538854187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538854187 NPI number — ROY ABUANGEON AMBOMU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBOMU
Provider First Name:
ROY
Provider Middle Name:
ABUANGEON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538854187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3318 PARKFORD MANOR TERRES APT D
Provider Second Line Business Mailing Address:
915 RHODE ISLAND AVE NW, WASHINGTON,
Provider Business Mailing Address City Name:
DC
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-469-1313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HILLCREST CHILDREN AND FAMILY CENTER 915 RHODE ISLAND A
Provider Second Line Business Practice Location Address:
D.C
Provider Business Practice Location Address City Name:
NW DC
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20001-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-232-6100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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