Healthcare Provider Details

I. General information

NPI: 1730580366
Provider Name (Legal Business Name): INCEPTION HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 BARTRAM PARK BLVD UNIT 1118
JACKSONVILLE FL
32258-5296
US

IV. Provider business mailing address

14701 BARTRAM PARK BLVD UNIT 1118
JACKSONVILLE FL
32258-5296
US

V. Phone/Fax

Practice location:
  • Phone: 561-232-4519
  • Fax:
Mailing address:
  • Phone: 561-232-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberPS43223
License Number StateFL

VIII. Authorized Official

Name: DR. JULIO LUIS CAMACHO
Title or Position: PRESIDENT AND CEO
Credential: PHARM.D.
Phone: 561-232-4519