Healthcare Provider Details

I. General information

NPI: 1518957307
Provider Name (Legal Business Name): MARIBEL YAP MAMONLUK-CHUA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 02/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE SUITE008
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE SUITE008
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-526-3897
  • Fax: 202-526-7723
Mailing address:
  • Phone: 202-526-3897
  • Fax: 202-526-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD 037327
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: