Provider Demographics
NPI:1811464209
Name:KAMGA, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KAMGA
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 1:13540 N FLORIDA AVE STE 202A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3210
Mailing Address - Country:US
Mailing Address - Phone:813-230-3332
Mailing Address - Fax:
Practice Address - Street 1:13540 N FLORIDA AVE STE 202A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3210
Practice Address - Country:US
Practice Address - Phone:813-999-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities