Provider Demographics
NPI:1710226642
Name:YAMBA, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:YAMBA
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 1:412 BURNT MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4405
Mailing Address - Country:US
Mailing Address - Phone:240-643-6925
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW STE 350
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2166
Practice Address - Country:US
Practice Address - Phone:202-545-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide