=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518708783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARWEN FAYE YAMBOT ALBANO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 12/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20201 S. CRAWFORD
-----------------------------------------------------
City | OLYMPIA FIELOS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-747-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2024 A SIMOUN STREET, BARANGAY 498
-----------------------------------------------------
City | SAMPALOC
-----------------------------------------------------
State | MANILA
-----------------------------------------------------
Zip | 00000
-----------------------------------------------------
Country | PH
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------