Provider Demographics
NPI:1700328259
Name:AYAMBA, JOHN TAMBE (MASTER'S IN THEOLOGY)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:TAMBE
Last Name:AYAMBA
Suffix:
Gender:M
Credentials:MASTER'S IN THEOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 N MERIDIAN AVE
Mailing Address - Street 2:APT 253
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1067
Mailing Address - Country:US
Mailing Address - Phone:202-802-5997
Mailing Address - Fax:
Practice Address - Street 1:5400 NW 23RD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2367
Practice Address - Country:US
Practice Address - Phone:202-802-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCM11171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator