Healthcare Provider Details

I. General information

NPI: 1144754151
Provider Name (Legal Business Name): CAMEO CARTER MD 2, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 07/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD SUITE 106A
REDLANDS CA
92373-4775
US

IV. Provider business mailing address

101 E REDLANDS BLVD SUITE 106A
REDLANDS CA
92373-4775
US

V. Phone/Fax

Practice location:
  • Phone: 909-792-8866
  • Fax: 909-792-9395
Mailing address:
  • Phone: 909-792-8866
  • Fax: 909-792-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA94105
License Number StateCA

VIII. Authorized Official

Name: DR. CAMEO CARTER
Title or Position: CEO
Credential: MD
Phone: 909-792-8866