Provider Demographics
NPI:1679116271
Name:ISAMBO, CHRISTELLE
Entity Type:Individual
Prefix:
First Name:CHRISTELLE
Middle Name:
Last Name:ISAMBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15125 CARDIN PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5338
Mailing Address - Country:US
Mailing Address - Phone:202-660-8083
Mailing Address - Fax:
Practice Address - Street 1:15125 CARDIN PL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5338
Practice Address - Country:US
Practice Address - Phone:202-660-8083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide