Organization
AMBOSELI MEDICAL AND WELLNESS CTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAPHAEL GASTON LOUTOBY MD (CEO)
(301) 660-3035
Entity
Organization
Contact information
Practice address
8320 FENTON STREET SUITE 122, SILVER SPRING, MD 20910
(301) 660-3035
Mailing address
5425 WISCONSIN AVE STE 600, CHEVY CHASE, MD 20815-3588
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
D0070195
MD
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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