Healthcare Provider Details

I. General information

NPI: 1053416115
Provider Name (Legal Business Name): JORGE LUIS CAMINA JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5262 GOLDEN GATE PKWY
NAPLES FL
34116-7670
US

IV. Provider business mailing address

347 BURNT PINE DR
NAPLES FL
34119-9775
US

V. Phone/Fax

Practice location:
  • Phone: 239-353-4101
  • Fax:
Mailing address:
  • Phone: 239-348-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: