Provider Demographics
NPI:1194570259
Name:AMBACH MA, P.C.
Entity type:Organization
Organization Name:AMBACH MA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-410-8441
Mailing Address - Street 1:285 N EL CAMINO REAL STE 110
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5384
Mailing Address - Country:US
Mailing Address - Phone:858-225-1922
Mailing Address - Fax:858-327-9656
Practice Address - Street 1:285 N EL CAMINO REAL STE 110
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5384
Practice Address - Country:US
Practice Address - Phone:858-225-1922
Practice Address - Fax:858-327-9656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty