Healthcare Provider Details

I. General information

NPI: 1881402881
Provider Name (Legal Business Name): DANIEL CAMBAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

1072 VERBENA CT
POMONA CA
91766-6911
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95129266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: