Healthcare Provider Details

I. General information

NPI: 1992969273
Provider Name (Legal Business Name): MIRTA CAMINERO TEJEDOR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10651 SW 88TH ST SUITE 101
MIAMI FL
33176-1569
US

IV. Provider business mailing address

10651 SW 88TH ST SUITE 101
MIAMI FL
33176-1569
US

V. Phone/Fax

Practice location:
  • Phone: 305-412-6222
  • Fax: 305-412-8333
Mailing address:
  • Phone: 305-412-6222
  • Fax: 305-412-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME 56828
License Number StateFL

VIII. Authorized Official

Name: MIRTA CAMINERO -TEJEDOR
Title or Position: OWNER
Credential: MD
Phone: 305-412-6222