Provider Demographics
NPI:1396765939
Name:CAMBA, LEONILA D (MD)
Entity type:Individual
Prefix:
First Name:LEONILA
Middle Name:D
Last Name:CAMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 THONOTOSASSA RD
Mailing Address - Street 2:SUITE 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:813-759-1291
Practice Address - Street 1:2004 THONOTOSASSA RD
Practice Address - Street 2:SUITE 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:813-759-1291
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065228207R00000X
FLME00065228207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257820400Medicaid
FL23604Medicare ID - Type Unspecified
FL257820400Medicaid