MEDICARE: DR. BLAS G CAMILO DOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP800	FL

General Provider Information

NPI Number	:	1912964727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAS G CAMILO DOM

Provider Business Mailing Address
First Line	:	PO BOX 450804
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33345-0804
Country	:	US
Telephone Number	:	954-934-0880
Fax Number	:	954-723-9759

Provider Business Practice Location Address
First Line	:	7301 N UNIVERSITY DR
Second Line	:	SUITE 205
City	:	TAMARAC
State	:	FL
Zip	:	33321-2919
Country	:	US
Telephone Number	:	954-934-0880
Fax Number	:	954-723-9759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	11/09/2009

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Directions to “ DR. BLAS G CAMILO DOM” Practice Location

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