Provider Demographics
NPI:1427048495
Name:CAMILO, RAISA D (MD)
Entity type:Individual
Prefix:MRS
First Name:RAISA
Middle Name:D
Last Name:CAMILO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2167
Mailing Address - Country:US
Mailing Address - Phone:863-385-4711
Mailing Address - Fax:863-386-4301
Practice Address - Street 1:4958 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2167
Practice Address - Country:US
Practice Address - Phone:863-385-4711
Practice Address - Fax:863-386-4301
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061030208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373302500Medicaid
FL373302500Medicaid