Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN22220 | FL |
NPI | 1013335736 |
---|---|
Provider Name | Camille Medina Cintron |
First Address | Tampa, FL 33612-1820 |
Second Address | Tampa, FL 33612-1820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 21/12/2018 |