Healthcare Provider Details

I. General information

NPI: 1396983698
Provider Name (Legal Business Name): ST CLOUD EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

IV. Provider business mailing address

8390 CHAMPIONS GATE BLVD SUITE 306
CHAMPIONS GATE FL
33896-8310
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-2135
  • Fax:
Mailing address:
  • Phone: 407-390-1677
  • Fax: 407-390-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE CAMBO
Title or Position: PRESIDENT
Credential: MD
Phone: 407-390-1677