Provider Demographics
NPI:1225342785
Name:MUNGANGA, CAMILLE (NP)
Entity Type:Individual
Prefix:MR
First Name:CAMILLE
Middle Name:
Last Name:MUNGANGA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4182 N 1ST ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-4313
Mailing Address - Country:US
Mailing Address - Phone:559-224-3300
Mailing Address - Fax:559-224-3306
Practice Address - Street 1:4182 N 1ST ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-4313
Practice Address - Country:US
Practice Address - Phone:559-224-3300
Practice Address - Fax:559-224-3306
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFG498YMedicare PIN