Provider Demographics
NPI:1720552292
Name:LACAMBRA, MARIE ASHLEY
Entity Type:Individual
Prefix:
First Name:MARIE ASHLEY
Middle Name:
Last Name:LACAMBRA
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 1:1237 ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1415
Mailing Address - Country:US
Mailing Address - Phone:818-913-0870
Mailing Address - Fax:
Practice Address - Street 1:903 CRENSHAW BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-1965
Practice Address - Country:US
Practice Address - Phone:323-549-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant