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NPI Code Detail

MEDICARE: MISS MIRABEL NDI AMBANG I MD

MEDICARE: MISS MIRABEL NDI AMBANG I MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1598443525
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MIRABEL NDI AMBANG I MD
Provider Business Mailing Address
First Line : 3405 DODGE PARK RD APT 201
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-2013
Country : US
Telephone Number : 202-702-6423
Fax Number :
Provider Business Practice Location Address
First Line : 3405 DODGE PARK RD APT 201
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-2013
Country : US
Telephone Number : 202-702-6423
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2023
Last Update Date : 07/10/2023

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