Healthcare Provider Details

I. General information

NPI: 1154879278
Provider Name (Legal Business Name): DIALIS ENEIDA CAMACHO LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2016
Last Update Date: 09/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8203 NW 31ST AVE APT. G41
GAINESVILLE FL
32606-6289
US

IV. Provider business mailing address

8203 NW 31ST AVE APT. G41
GAINESVILLE FL
32606-6289
US

V. Phone/Fax

Practice location:
  • Phone: 787-228-3444
  • Fax:
Mailing address:
  • Phone: 787-228-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: