Provider Demographics
NPI:1447286190
Name:CAMEJO, LARISSA (MD)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:CAMEJO
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 1:11211 PROSPERITY FARMS RD STE D127
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3449
Mailing Address - Country:US
Mailing Address - Phone:561-223-6557
Mailing Address - Fax:561-526-8754
Practice Address - Street 1:11211 PROSPERITY FARMS RD STE D127
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3449
Practice Address - Country:US
Practice Address - Phone:561-223-6557
Practice Address - Fax:561-526-8754
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429218207W00000X
FLME106908207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004619200Medicaid
FL14J82OtherBC/BS
FL14J82OtherBC/BS
FLFN082ZMedicare PIN