1851537633 NPI number — MS. ILEANA APONTE-CAMACHO MD

Table of content: MS. ILEANA APONTE-CAMACHO MD (NPI 1851537633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851537633 NPI number — MS. ILEANA APONTE-CAMACHO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
APONTE-CAMACHO
Provider First Name:
ILEANA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
APONTE-CAMACHO
Provider Other First Name:
ILEANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851537633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11310 S ORANGE BLOSSOM TRL STE 109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32837-9421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-413-3200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4365 HUNTERS PARK LN # 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32837-7614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-413-3200
Provider Business Practice Location Address Fax Number:
407-286-4419
Provider Enumeration Date:
12/27/2008

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: 208D00000X , with the licence number:  17450 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ACN573 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: IA127X . This is a "MEDICARE UPIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 013503400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108897600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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