Provider Demographics
NPI:1972784122
Name:KAMBUROV, MARIANA PAVLOVA (LMT, DOM, LIC AC)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:PAVLOVA
Last Name:KAMBUROV
Suffix:
Gender:F
Credentials:LMT, DOM, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4113
Mailing Address - Country:US
Mailing Address - Phone:352-378-8002
Mailing Address - Fax:352-378-8002
Practice Address - Street 1:1209 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4113
Practice Address - Country:US
Practice Address - Phone:352-378-8002
Practice Address - Fax:352-378-8002
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47164225700000X
FLAP2980171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1568757854OtherNPPES