Provider Demographics
NPI:1770907594
Name:AMBROSIO, MARK (RRT, RCP)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:AMBROSIO
Suffix:
Gender:M
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 THOMPSON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1792
Mailing Address - Country:US
Mailing Address - Phone:818-644-7313
Mailing Address - Fax:
Practice Address - Street 1:1043 THOMPSON AVE APT 3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1792
Practice Address - Country:US
Practice Address - Phone:818-644-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248652279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care