Healthcare Provider Details

I. General information

NPI: 1508772179
Provider Name (Legal Business Name): JOSE ALEJANDRO CAMARGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 SANDY PORTER RD APT 101
CHARLOTTE NC
28273-4008
US

IV. Provider business mailing address

2115 SANDY PORTER RD APT 101
CHARLOTTE NC
28273-4008
US

V. Phone/Fax

Practice location:
  • Phone: 754-707-1405
  • Fax:
Mailing address:
  • Phone: 754-707-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number000040794604
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: