Provider Demographics
NPI:1740997147
Name:AYAMBA, JULIUS ABANGA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JULIUS
Middle Name:ABANGA
Last Name:AYAMBA
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10915 CATTAIL CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-7257
Mailing Address - Country:US
Mailing Address - Phone:571-532-1274
Mailing Address - Fax:
Practice Address - Street 1:12380 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1043
Practice Address - Country:US
Practice Address - Phone:571-532-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185003363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care