Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 25555 | FL |
NPI | 1013388586 |
---|---|
Provider Name | Camilo Edgardo Garzonlopez |
First Address | Doral, FL 33178-4940 |
Second Address | Miami, FL 33150-2032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2015 |
Last Update Date | 09/10/2015 |