Provider Demographics
NPI:1427181262
Name:ATHLEO L. CAMBRE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ATHLEO L. CAMBRE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHLEO
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:CAMBRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:310-777-6677
Mailing Address - Street 1:9201 W SUNSET BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3701
Mailing Address - Country:US
Mailing Address - Phone:310-777-6677
Mailing Address - Fax:310-777-6680
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-777-6677
Practice Address - Fax:310-777-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60551208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568499549OtherLEGACY TYPE 1 NPI
CA1568499549OtherLEGACY TYPE 1 NPI