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General NPI Number Information
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NPI Number | 1457410227
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Entity Type | Organization
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Legal Business Name | IMBERCT MEDICAL SERVICES INC
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 1414 NW 107TH AVE SUITE 203
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City | DORAL
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State | FL
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Zip | 33172-2732
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Country | US
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Telephone | 305-594-7214
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Fax | 305-594-7545
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Provider Business Mailing Address
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Address Line | 1414 NW 107TH AVE SUITE 203
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City | DORAL
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State | FL
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Zip | 33172-2732
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Country | US
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Telephone | 305-594-7214
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Fax | 305-594-7545
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GUILLERMO CAMEJO
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Credential |
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Telephone | 305-594-7214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC7511
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License Number State | FL
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