Individual
MS. RITA LEE AMBROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SPECIALIST
Contact information
Practice address
21 WALDEN SQUARE ROAD, UNIT, 688, MA 02140-3434
(617) 955-2335
Mailing address
21 WALDENSQUARE ROAD, UNIT 688, NORTH CAMBRIDGE, MA 02140-3434
(337) 222-1444
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11.3677013
FL
174400000X
Specialist
113677013
FL
174400000X
Specialist
EIN 11.3677013
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113677013
SPECIALIST
FL
05
—
113677013
—
FL
05
—
1144462664
—
FL
Enumeration date
03/30/2009
Last updated
12/31/2019
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