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NPI Code Detail

MEDICARE: MR. CAMILLE MUNGANGA NP

MEDICARE: MR. CAMILLE MUNGANGA NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner19525CA

General Provider Information

NPI Number : 1225342785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CAMILLE MUNGANGA NP
Provider Business Mailing Address
First Line : 4182 N 1ST ST
Second Line : SUITE 105
City : FRESNO
State : CA
Zip : 93726-4313
Country : US
Telephone Number : 559-224-3300
Fax Number : 559-224-3306
Provider Business Practice Location Address
First Line : 4182 N 1ST ST
Second Line : SUITE 105
City : FRESNO
State : CA
Zip : 93726-4313
Country : US
Telephone Number : 559-224-3300
Fax Number : 559-224-3306
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2010
Last Update Date : 01/09/2016

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