1114236924 NPI number — DR. WARNER MBUILA MAMPUYA M.D.

Table of content: DR. WARNER MBUILA MAMPUYA M.D. (NPI 1114236924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114236924 NPI number — DR. WARNER MBUILA MAMPUYA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAMPUYA
Provider First Name:
WARNER
Provider Middle Name:
MBUILA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114236924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5382 RUE DU PRESIDENT KENNEDY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERBROOKE
Provider Business Mailing Address State Name:
QUEBEC
Provider Business Mailing Address Postal Code:
J1N 2L1
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
819-864-7826
Provider Business Mailing Address Fax Number:
819-864-7826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 EUCLID AVE
Provider Second Line Business Practice Location Address:
DESK JB-1
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-445-6320
Provider Business Practice Location Address Fax Number:
216-444-8856
Provider Enumeration Date:
09/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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