Provider Demographics
NPI:1689842353
Name:LEONILA D CAMBA MD PA
Entity Type:Organization
Organization Name:LEONILA D CAMBA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-759-1290
Mailing Address - Street 1:2004 THONOTOSASSA RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-2915
Mailing Address - Country:US
Mailing Address - Phone:813-759-1290
Mailing Address - Fax:
Practice Address - Street 1:2004 THONOTOSASSA RD
Practice Address - Street 2:STE 101
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2915
Practice Address - Country:US
Practice Address - Phone:813-759-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065228207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK977Medicare PIN