Organization
MARK AND KAMBOUR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANA VICIANA MD (DIRECTOR)
(305) 503-6320
Entity
Organization
Contact information
Practice address
4665 PONCE DE LEON BLVD, CORAL GABLES, FL 33146-2101
(305) 503-5610
Mailing address
PO BOX 100914, ATLANTA, GA 30384-0914
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME60651
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L9100
BCBS
FL
Enumeration date
10/25/2011
Last updated
10/25/2011
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