1609048586 NPI number — JORGE G CAMARA M D INC

Table of content: (NPI 1609048586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609048586 NPI number — JORGE G CAMARA M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORGE G CAMARA M D INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CAMARA EYE CLINIC
Provider Other Organization Name Type Code:
3
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:
1609048586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 ALA MOANA BLVD
Provider Second Line Business Mailing Address:
SUITE 5-300
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-4990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-524-1057
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 ALA MOANA BLVD
Provider Second Line Business Practice Location Address:
SUITE 5-300
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-524-1057
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMARA
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OPHTHALMOLOGIST
Authorized Official Telephone Number:
808-524-1057

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  MD4325 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A0010510 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 01011901 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9844609 . This is a "UNIVERSITY HEALTH ALLIANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".