Healthcare Provider Details

I. General information

NPI: 1467218115
Provider Name (Legal Business Name): JHONNATHAN CAMACHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8317 GUNN HWY
TAMPA FL
33626-1608
US

IV. Provider business mailing address

8317 GUNN HWY
TAMPA FL
33626-1608
US

V. Phone/Fax

Practice location:
  • Phone: 813-326-2724
  • Fax:
Mailing address:
  • Phone: 813-326-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: