Provider Demographics
NPI:1346085586
Name:AMBROSE, TILBE (PHD)
Entity type:Individual
Prefix:
First Name:TILBE
Middle Name:
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TILBE
Other - Middle Name:
Other - Last Name:YILDIRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2535 CAMINO DEL RIO S STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2535 CAMINO DEL RIO S STE 303
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3757
Practice Address - Country:US
Practice Address - Phone:619-940-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265056048OtherOLD NPI