Healthcare Provider Details

I. General information

NPI: 1801383971
Provider Name (Legal Business Name): MARIA CRISTINA CRUZ CAMACHO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5071 374TH MEDICAL GROUP
APO AP
96328-5071
US

IV. Provider business mailing address

UNIT 5071
APO AP
96328-5071
US

V. Phone/Fax

Practice location:
  • Phone: 315-784-7740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102205820
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number102205820
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: