1275706855 NPI number — DR. MARIA R CAMACHO OD

Table of content: DR. MARIA R CAMACHO OD (NPI 1275706855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275706855 NPI number — DR. MARIA R CAMACHO OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMACHO
Provider First Name:
MARIA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275706855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 76
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-0076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-3545
Provider Business Mailing Address Fax Number:
787-854-3555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSPITAL MANATI MEDICAL CENTER DR OTERO LOPEZ
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-3545
Provider Business Practice Location Address Fax Number:
787-854-3555
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  561 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 077144 . This is a "LA CRUZ AZUL DE PUERTO RI" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 220059 . This is a "HUMANA HEALTH (HMO)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 7250074 . This is a "HUMANA INSURANCE (PPO)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".