Provider Demographics
NPI:1356526099
Name:KAMBE, VINCENT J (DPT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:J
Last Name:KAMBE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:408 HIGUERA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6135
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:82013 DR CARREON BLVD
Practice Address - Street 2:#1
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5832
Practice Address - Country:US
Practice Address - Phone:760-347-6195
Practice Address - Fax:760-347-2849
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT34370AMedicare PIN
CABL036ZMedicare PIN