Provider Demographics
NPI:1073828976
Name:LACAMBRA SERVICES INC
Entity Type:Organization
Organization Name:LACAMBRA SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LACAMBRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-403-7410
Mailing Address - Street 1:7205 MARTIN WAY E
Mailing Address - Street 2:SUITE A-69
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5555
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7205 MARTIN WAY E
Practice Address - Street 2:SUITE A-69
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5555
Practice Address - Country:US
Practice Address - Phone:206-403-7410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty