Healthcare Provider Details

I. General information

NPI: 1083790935
Provider Name (Legal Business Name): ANGEL CAMACHO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRARNG SOHO CAMP.SANTIAGO
SALINAS PR
00902-3786
US

IV. Provider business mailing address

LOS FLORES 411 HC 02 BOX 10185
YAUCO PR
00698-9603
US

V. Phone/Fax

Practice location:
  • Phone: 787-824-0284
  • Fax: 787-824-2022
Mailing address:
  • Phone: 787-824-0284
  • Fax: 787-824-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number000883
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: