Provider Demographics
NPI:1598443525
Name:AMBANG, MIRABEL NDI I (MD)
Entity Type:Individual
Prefix:MISS
First Name:MIRABEL
Middle Name:NDI
Last Name:AMBANG
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MIRABEL
Other - Middle Name:NDI
Other - Last Name:AMBANG
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3405 DODGE PARK RD APT 201
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2013
Mailing Address - Country:US
Mailing Address - Phone:202-702-6423
Mailing Address - Fax:
Practice Address - Street 1:3405 DODGE PARK RD APT 201
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2013
Practice Address - Country:US
Practice Address - Phone:202-702-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health