Basic Information
Provider Information
NPI: 1013424951
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAHAMBING
FirstName: MYRA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PTA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12411 SLAUSON AVE., UNIT G
Address2:  
City: WHITTIER
State: CA
PostalCode: 90606
CountryCode: US
TelephoneNumber: 5626935449
FaxNumber:  
Practice Location
Address1: 12411 SLAUSON AVE., UNIT G
Address2:  
City: WHITTIER
State: CA
PostalCode: 90606
CountryCode: US
TelephoneNumber: 5626935449
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/31/2017
LastUpdateDate: 12/31/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225200000XPTA3324CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant 

No ID Information.


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