Provider Demographics
NPI:1538854187
Name:AMBOMU, ROY ABUANGEON
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:ABUANGEON
Last Name:AMBOMU
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 1:3318 PARKFORD MANOR TERRES APT D
Mailing Address - Street 2:915 RHODE ISLAND AVE NW, WASHINGTON,
Mailing Address - City:DC
Mailing Address - State:DC
Mailing Address - Zip Code:20001
Mailing Address - Country:US
Mailing Address - Phone:202-469-1313
Mailing Address - Fax:
Practice Address - Street 1:HILLCREST CHILDREN AND FAMILY CENTER 915 RHODE ISLAND A
Practice Address - Street 2:D.C
Practice Address - City:NW DC
Practice Address - State:DC
Practice Address - Zip Code:20001-2000
Practice Address - Country:US
Practice Address - Phone:202-232-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251S00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health