Healthcare Provider Details

I. General information

NPI: 1508113895
Provider Name (Legal Business Name): CARCAMO PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 RED BUG LAKE RD SUITE 1070
OVIEDO FL
32765-6591
US

IV. Provider business mailing address

7560 RED BUG LAKE RD SUITE 1070
OVIEDO FL
32765-6591
US

V. Phone/Fax

Practice location:
  • Phone: 407-366-4040
  • Fax: 407-366-0025
Mailing address:
  • Phone: 407-366-4040
  • Fax: 407-366-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME96797
License Number StateFL

VIII. Authorized Official

Name: DR. ANTONIO DE JESUS CARCAMO
Title or Position: OWNER
Credential: M.D.
Phone: 407-366-4040