Healthcare Provider Details

I. General information

NPI: 1306548086
Provider Name (Legal Business Name): NICOLAS FARELO CAMARGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14723 CUMBERLAND DR APT 208
DELRAY BEACH FL
33446-1341
US

IV. Provider business mailing address

14723 CUMBERLAND DR APT 208
DELRAY BEACH FL
33446-1341
US

V. Phone/Fax

Practice location:
  • Phone: 561-990-8598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: