Provider Demographics
NPI:1114236924
Name:MAMPUYA, WARNER MBUILA (MD)
Entity Type:Individual
Prefix:DR
First Name:WARNER
Middle Name:MBUILA
Last Name:MAMPUYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5382 RUE DU PRESIDENT KENNEDY
Mailing Address - Street 2:
Mailing Address - City:SHERBROOKE
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J1N 2L1
Mailing Address - Country:CA
Mailing Address - Phone:819-864-7826
Mailing Address - Fax:819-864-7826
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DESK JB-1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-6320
Practice Address - Fax:216-444-8856
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program