MEDICARE: RELIDIS TIBONG AMBOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		OH
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1053005900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RELIDIS TIBONG AMBOCK

Provider Business Mailing Address
First Line	:	8210 DESOTO DR APT B111
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2169
Country	:	US
Telephone Number	:	513-837-3941
Fax Number	:

Provider Business Practice Location Address
First Line	:	8210 DESOTO DR APT B111
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2169
Country	:	US
Telephone Number	:	513-837-3941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	08/01/2023

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