Healthcare Provider Details

I. General information

NPI: 1104559012
Provider Name (Legal Business Name): KATRINA CAMBIGUE RRT-ACCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BICENTENNIAL WAY STE 190
SANTA ROSA CA
95403-2149
US

IV. Provider business mailing address

401 BICENTENNIAL WAY STE 190
SANTA ROSA CA
95403-2149
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3755
  • Fax:
Mailing address:
  • Phone: 707-571-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number40384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: