1154415180 NPI number — MRS. ILEANA CAMACHO LND

Table of content: MRS. ILEANA CAMACHO LND (NPI 1154415180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154415180 NPI number — MRS. ILEANA CAMACHO LND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMACHO
Provider First Name:
ILEANA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LND
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:
1154415180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
425 ROAD 693
Provider Second Line Business Mailing Address:
PMB 179
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-796-0959
Provider Business Mailing Address Fax Number:
787-796-0959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SARDINERA BEACH BUILDING ROAD 693
Provider Second Line Business Practice Location Address:
SUITE 11 URB. COSTA DE ORO
Provider Business Practice Location Address City Name:
DORADO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-796-0959
Provider Business Practice Location Address Fax Number:
787-796-0959
Provider Enumeration Date:
10/03/2006

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: 133N00000X , with the licence number:  806 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 133NN1002X , with the licence number: 806 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: NUT 036 . This is a "PREFFERED HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6460066 . This is a "HUMANA HEALTH PLAN DE PR" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6606607381 . This is a "MCS CLASSICARE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com