Provider Demographics
NPI:1134904667
Name:KAMARA, MINKAILU
Entity type:Individual
Prefix:
First Name:MINKAILU
Middle Name:
Last Name:KAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W TOWNLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5335
Mailing Address - Country:US
Mailing Address - Phone:602-396-9882
Mailing Address - Fax:
Practice Address - Street 1:4410 W TOWNLEY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-5335
Practice Address - Country:US
Practice Address - Phone:602-396-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician