Provider Demographics
NPI:1013264399
Name:LA CAMBRA CO
Entity Type:Organization
Organization Name:LA CAMBRA CO
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:DOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-424-7000
Mailing Address - Street 1:727 N WACO AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3951
Mailing Address - Country:US
Mailing Address - Phone:913-424-7000
Mailing Address - Fax:
Practice Address - Street 1:727 N WACO AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3951
Practice Address - Country:US
Practice Address - Phone:913-424-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS50401207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty