Healthcare Provider Details

I. General information

NPI: 1699299354
Provider Name (Legal Business Name): CEDRIC MALAMBU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

15301 AVEIRO RD
FONTANA CA
92337-0981
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7928
  • Fax:
Mailing address:
  • Phone: 310-908-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number31591
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number010921
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: