Provider Demographics
NPI:1073339701
Name:PULGAR GUERRA, KAMILA
Entity type:Individual
Prefix:
First Name:KAMILA
Middle Name:
Last Name:PULGAR GUERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 SW 9TH PL APT 1
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6400
Mailing Address - Country:US
Mailing Address - Phone:786-348-8036
Mailing Address - Fax:
Practice Address - Street 1:4625 SW 9TH PL APT 1
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6400
Practice Address - Country:US
Practice Address - Phone:786-348-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician