Provider Demographics
NPI:1174901219
Name:CAMBOU, MARY CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:CAMBOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:310-301-8751
Practice Address - Street 1:1399 ROXBURY DR STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4709
Practice Address - Country:US
Practice Address - Phone:310-557-2273
Practice Address - Fax:310-557-3450
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2022-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA155665207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease