Healthcare Provider Details

I. General information

NPI: 1487713392
Provider Name (Legal Business Name): KAMBRA PHOEBUS N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 S DORA ST STE A
UKIAH CA
95482-5736
US

IV. Provider business mailing address

1081 S DORA ST STE A
UKIAH CA
95482-5736
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-8628
  • Fax: 707-462-8628
Mailing address:
  • Phone: 707-462-8628
  • Fax: 707-462-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: