Healthcare Provider Details

I. General information

NPI: 1114854726
Provider Name (Legal Business Name): BRYCE KAMSTRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 BRUNSON DR
CORAL GABLES FL
33146-2412
US

IV. Provider business mailing address

7350 SW 58TH CT APT 628
SOUTH MIAMI FL
33143-2388
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-3666
  • Fax:
Mailing address:
  • Phone: 303-726-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1683665
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: