Healthcare Provider Details

I. General information

NPI: 1255548327
Provider Name (Legal Business Name): JOSE CAMACHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOSE ANGEL CAMACHO MD

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST FL 6
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

PO BOX 495
DEL MAR CA
92014-0495
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-2757
  • Fax:
Mailing address:
  • Phone: 858-837-2990
  • Fax: 858-793-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC43174
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberC43174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: