Healthcare Provider Details

I. General information

NPI: 1750726527
Provider Name (Legal Business Name): ISRAEL ENCABO CAMET II CRNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 OLD GEORGETOWN RD
BETHESDA MD
20814-1422
US

IV. Provider business mailing address

25866 SARAZEN DR
SOUTH RIDING VA
20152-2594
US

V. Phone/Fax

Practice location:
  • Phone: 301-896-7610
  • Fax:
Mailing address:
  • Phone: 240-338-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number0001210008
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: