Provider Demographics
NPI:1649818113
Name:KAMBOH, NISHA
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:
Last Name:KAMBOH
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 1:7195 CHERRYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5042
Mailing Address - Country:US
Mailing Address - Phone:951-319-9693
Mailing Address - Fax:
Practice Address - Street 1:7195 CHERRYWOOD CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5042
Practice Address - Country:US
Practice Address - Phone:951-310-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty