Provider Demographics
NPI:1104853514
Name:CHAMBI, MIRNA R (MD)
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:R
Last Name:CHAMBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIRNA
Other - Middle Name:R
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-1245
Mailing Address - Country:US
Mailing Address - Phone:714-821-6506
Mailing Address - Fax:714-229-0476
Practice Address - Street 1:7151 LINCOLN AVE
Practice Address - Street 2:SUITE A & B
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4613
Practice Address - Country:US
Practice Address - Phone:714-821-6506
Practice Address - Fax:714-229-0476
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A531490Medicaid
CA00A531490Medicaid
CAF88085Medicare UPIN