Healthcare Provider Details

I. General information

NPI: 1750799037
Provider Name (Legal Business Name): ANDREA CAMBIO MD PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 DEL PRADO BLVD N SUITE 201
CAPE CORAL FL
33909-2278
US

IV. Provider business mailing address

632 DEL PRADO BLVD N SUITE 201
CAPE CORAL FL
33909-2278
US

V. Phone/Fax

Practice location:
  • Phone: 239-829-7102
  • Fax: 239-829-7104
Mailing address:
  • Phone: 239-829-7102
  • Fax: 239-829-7104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME98370
License Number StateFL

VIII. Authorized Official

Name: NEFRITA LOGAN
Title or Position: PROVIDER SERVICE REP
Credential:
Phone: 407-875-2080