Provider Demographics
NPI:1912964727
Name:CAMILO, BLAS G (DOM)
Entity Type:Individual
Prefix:DR
First Name:BLAS
Middle Name:G
Last Name:CAMILO
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 450804
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-0804
Mailing Address - Country:US
Mailing Address - Phone:954-934-0880
Mailing Address - Fax:954-723-9759
Practice Address - Street 1:7301 N UNIVERSITY DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2919
Practice Address - Country:US
Practice Address - Phone:954-934-0880
Practice Address - Fax:954-723-9759
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist