Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 338 | FL |
NPI | 1154879278 |
---|---|
Provider Name | Dialis Eneida Camacho |
First Address | Gainesville, FL 32606-6289 |
Second Address | Gainesville, FL 32606-6289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2016 |
Last Update Date | 18/09/2016 |