Provider Demographics
NPI:1972119832
Name:LACAMBRA, AYNES
Entity type:Individual
Prefix:
First Name:AYNES
Middle Name:
Last Name:LACAMBRA
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 1:91-944 MAILANI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2255
Mailing Address - Country:US
Mailing Address - Phone:917-597-9461
Mailing Address - Fax:808-379-1051
Practice Address - Street 1:91-944 MAILANI ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2255
Practice Address - Country:US
Practice Address - Phone:917-597-9461
Practice Address - Fax:808-379-1051
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI80259163WH0200X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI80259Medicaid