Provider Demographics
NPI:1144754151
Name:CAMEO CARTER MD 2, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CAMEO CARTER MD 2, A PROFESSIONAL CORPORATION
Other - Org Name:GARDEN PEDIATRIC URGENT CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMEO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-792-8866
Mailing Address - Street 1:101 E REDLANDS BLVD
Mailing Address - Street 2:SUITE 106A
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4775
Mailing Address - Country:US
Mailing Address - Phone:909-792-8866
Mailing Address - Fax:909-792-9395
Practice Address - Street 1:101 E REDLANDS BLVD
Practice Address - Street 2:SUITE 106A
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4775
Practice Address - Country:US
Practice Address - Phone:909-792-8866
Practice Address - Fax:909-792-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94105261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care