Healthcare Provider Details

I. General information

NPI: 1699759936
Provider Name (Legal Business Name): BENJAMIN OCLARINO CAMACHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 SWEETWATER RD
NATIONAL CITY CA
91950
US

IV. Provider business mailing address

1615 SWEETWATER RD
NATIONAL CITY CA
91950-7655
US

V. Phone/Fax

Practice location:
  • Phone: 619-474-2233
  • Fax: 619-474-2211
Mailing address:
  • Phone: 619-474-2233
  • Fax: 619-474-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA052660
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA052660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: