Healthcare Provider Details

I. General information

NPI: 1356936439
Provider Name (Legal Business Name): ROSARIO CAMILO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10075 S JOG RD STE 201
BOYNTON BEACH FL
33437-3536
US

IV. Provider business mailing address

2199 NW 77TH WAY APT 203
PEMBROKE PINES FL
33024-3694
US

V. Phone/Fax

Practice location:
  • Phone: 561-733-1012
  • Fax:
Mailing address:
  • Phone: 954-732-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT15174
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: