Healthcare Provider Details

I. General information

NPI: 1922081207
Provider Name (Legal Business Name): KAMAL MASSIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

IV. Provider business mailing address

2700 UNIVERSITY SQUARE DR RADIOLOGY ASSOCIATES OF TAMPA
TAMPA FL
33612-5513
US

V. Phone/Fax

Practice location:
  • Phone: 281-766-0959
  • Fax:
Mailing address:
  • Phone: 813-251-5822
  • Fax: 813-254-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME88837
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME 88837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: