Healthcare Provider Details

I. General information

NPI: 1568932150
Provider Name (Legal Business Name): VICENTE JOSE GUARINO CAMGEMI SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12921 ENTRADA DR
ORLANDO FL
32837-4617
US

IV. Provider business mailing address

12921 ENTRADA DR
ORLANDO FL
32837-4617
US

V. Phone/Fax

Practice location:
  • Phone: 407-437-4858
  • Fax:
Mailing address:
  • Phone: 407-437-4858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number18-493
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: