Provider Demographics
NPI:1942904719
Name:WAMBALABA, OTIOLI WAMAKOTE (MD)
Entity Type:Individual
Prefix:DR
First Name:OTIOLI
Middle Name:WAMAKOTE
Last Name:WAMBALABA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2171
Mailing Address - Street 2:
Mailing Address - City:NAIROBI
Mailing Address - State:KENYA
Mailing Address - Zip Code:00621
Mailing Address - Country:KE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 DIVISION ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1326
Practice Address - Country:US
Practice Address - Phone:203-732-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program