Healthcare Provider Details

I. General information

NPI: 1891606679
Provider Name (Legal Business Name): ARNOLD KAMOGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 S 94TH AVE
TOLLESON AZ
85353-5753
US

IV. Provider business mailing address

4308 S 94TH AVE
TOLLESON AZ
85353-5753
US

V. Phone/Fax

Practice location:
  • Phone: 781-417-0457
  • Fax:
Mailing address:
  • Phone: 781-417-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10044999
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number336609
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: