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General NPI Number Information
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NPI Number | 1508113895
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Entity Type | Organization
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Legal Business Name | CARCAMO PEDIATRICS, INC
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 7560 RED BUG LAKE RD SUITE 1070
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City | OVIEDO
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State | FL
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Zip | 32765-6591
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Country | US
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Telephone | 407-366-4040
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Fax | 407-366-0025
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Provider Business Mailing Address
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Address Line | 7560 RED BUG LAKE RD SUITE 1070
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City | OVIEDO
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State | FL
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Zip | 32765-6591
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Country | US
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Telephone | 407-366-4040
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Fax | 407-366-0025
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTONIO DE JESUS CARCAMO
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Credential | M.D.
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Telephone | 407-366-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME96797
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License Number State | FL
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