Basic Information
| Provider Information | |||||||||
| NPI: | 1689737538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KABEMBA | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | MAYOMBO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 SEAGATE DR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336025789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132239319 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 TAMPA GENERAL CIR | ||||||||
| Address2: | SUITE A327 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138444396 | ||||||||
| FaxNumber: | 8138444972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 01/05/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME97928 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 4301082698 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 32280 | AZ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | ME97928 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 09230 | 01 | FL | BCBS | OTHER | 280711400 | 05 | FL | MEDICAID |