Healthcare Provider Details

I. General information

NPI: 1689737538
Provider Name (Legal Business Name): ALBERT MAYOMBO KABEMBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR SUITE A327
TAMPA FL
33606-3571
US

IV. Provider business mailing address

705 SEAGATE DR
TAMPA FL
33602-5789
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4396
  • Fax: 813-844-4972
Mailing address:
  • Phone: 813-223-9319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME97928
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301082698
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32280
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberME97928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: