MEDICARE: MISS YUDAIMI CAMPS

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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1780932590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS YUDAIMI CAMPS

Provider Business Mailing Address
First Line	:	2313 NW 2ND ST
Second Line	:	2
City	:	MIAMI
State	:	FL
Zip	:	33125-5273
Country	:	US
Telephone Number	:	305-417-0541
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 NW 2 ST
Second Line	:	2
City	:	MIAMI
State	:	FL
Zip	:	33125
Country	:	US
Telephone Number	:	305-417-0541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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