Provider Demographics
NPI:1821315557
Name:CHAMORRO, PAOLA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:TERESA
Last Name:CHAMORRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11924 FOREST HILL BLVD STE 10A-411
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6256
Mailing Address - Country:US
Mailing Address - Phone:561-425-2929
Mailing Address - Fax:561-810-1677
Practice Address - Street 1:7950 NW 53RD ST STE 104
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4681
Practice Address - Country:US
Practice Address - Phone:305-722-1333
Practice Address - Fax:305-668-8997
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME150042207N00000X
NY269204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine