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General NPI Number Information
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NPI Number | 1750272001
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Entity Type | Individual
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Provider Name | MS. NOELA J MOMBURI
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Gender | Female
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Dates
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Enumeration Date | 07/14/2025
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 4655 SALISBURY RD STE 220
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0959
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Country | US
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Telephone | 877-844-0053
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Fax | 904-900-2224
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Provider Business Mailing Address
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Address Line | 7733 PARADISE ISLAND BLVD APT 2510
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City | JACKSONVILLE
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State | FL
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Zip | 32256-3779
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Country | US
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Telephone | 904-881-7005
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Fax | 904-900-2224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW22063
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License Number State | FL
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