Provider Demographics
NPI:1417662834
Name:KAMBICH, DESTINY RAE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:RAE
Last Name:KAMBICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 BURSELL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2936
Mailing Address - Country:US
Mailing Address - Phone:541-301-9174
Mailing Address - Fax:
Practice Address - Street 1:3311 BURSELL RD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2936
Practice Address - Country:US
Practice Address - Phone:541-821-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health