Healthcare Provider Details

I. General information

NPI: 1164559449
Provider Name (Legal Business Name): NATALIA CAMACHO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR STE 1D
MELBOURNE FL
32901
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-729-6166
  • Fax: 321-952-9406
Mailing address:
  • Phone: 321-729-6166
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number102865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: