Individual
ALLEN OMBOUGNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SPT
Contact information
Practice address
4040 FAIRFAX DR STE 120, ARLINGTON, VA 22203-1613
(864) 546-9923
Mailing address
4301 N HENDERSON RD APT 203, ARLINGTON, VA 22203-2508
(864) 546-9923
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/14/2025
Last updated
01/14/2025
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