Provider Demographics
NPI:1043661481
Name:RAMBAL, EDMOND MEKIE
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:MEKIE
Last Name:RAMBAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 VETERANS HWY APT G6
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2319
Mailing Address - Country:US
Mailing Address - Phone:646-468-9181
Mailing Address - Fax:
Practice Address - Street 1:1405 VETERANS HWY APT G6
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2319
Practice Address - Country:US
Practice Address - Phone:646-468-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor