Provider Demographics
NPI:1295266989
Name:KAYUMBA, ANGE L
Entity type:Individual
Prefix:
First Name:ANGE
Middle Name:L
Last Name:KAYUMBA
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 1:6065 HILLCROFT ST STE 610
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1103
Mailing Address - Country:US
Mailing Address - Phone:281-846-6609
Mailing Address - Fax:832-917-1631
Practice Address - Street 1:12360 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2421
Practice Address - Country:US
Practice Address - Phone:832-329-2617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3746224Medicaid