Healthcare Provider Details

I. General information

NPI: 1831010149
Provider Name (Legal Business Name): AZIZ DIMITRI YERBANGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19026 N ST
OMAHA NE
68135-3562
US

IV. Provider business mailing address

19026 N ST
OMAHA NE
68135-3562
US

V. Phone/Fax

Practice location:
  • Phone: 646-228-1558
  • Fax:
Mailing address:
  • Phone: 646-228-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: