| Amboni Healthsource Llc | |
|
25630 Farrier Dr Richmond TX 77406-1468 | |
| (214) 830-9906 | |
| Not Available |
| Full Name | Amboni Healthsource Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 25630 Farrier Dr, Richmond, Texas |
| Authorized Official Name and Position | Prosper Kiswaga (MD) |
| Authorized Official Contact | 2148309906 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amboni Healthsource Llc 25630 Farrier Dr Richmond TX 77406-1468 Ph: (214) 830-9906 | Amboni Healthsource Llc 25630 Farrier Dr Richmond TX 77406-1468 Ph: (214) 830-9906 |
| NPI Number | 1073136800 |
|---|---|
| Provider Enumeration Date | 05/27/2020 |
| Last Update Date | 06/13/2024 |
| Certification Date | 06/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073136800 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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