Provider Demographics
NPI:1982826632
Name:CHAVEZ, CAMILLE DENISE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:DENISE
Last Name:CHAVEZ
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 1:9220 SW 72ND ST
Mailing Address - Street 2:STE 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3259
Mailing Address - Country:US
Mailing Address - Phone:305-595-6460
Mailing Address - Fax:
Practice Address - Street 1:9220 SW 72ND ST
Practice Address - Street 2:STE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3259
Practice Address - Country:US
Practice Address - Phone:305-595-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00683292086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378987000Medicaid
FL27604ZMedicare PIN
FL378987000Medicaid