Healthcare Provider Details

I. General information

NPI: 1508718073
Provider Name (Legal Business Name): KHUMBUZILE AMBOMU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7765 RIVERDALE RD APT 303 APT 303
NEW CARROLLTON MD
20784-3928
US

IV. Provider business mailing address

7765 RIVERDALE RD APT 303
NEW CARROLLTON MD
20784-3928
US

V. Phone/Fax

Practice location:
  • Phone: 240-351-1436
  • Fax:
Mailing address:
  • Phone: 240-351-1436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200005807
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: