Provider Demographics
NPI:1992969273
Name:MIRTA CAMINERO TEJEDOR MD PA
Entity type:Organization
Organization Name:MIRTA CAMINERO TEJEDOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMINERO -TEJEDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-412-6222
Mailing Address - Street 1:10651 SW 88TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1569
Mailing Address - Country:US
Mailing Address - Phone:305-412-6222
Mailing Address - Fax:305-412-8333
Practice Address - Street 1:10651 SW 88TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1569
Practice Address - Country:US
Practice Address - Phone:305-412-6222
Practice Address - Fax:305-412-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 56828207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME56828OtherFLORIDA MEDICAL LICENSE