Healthcare Provider Details

I. General information

NPI: 1124948187
Provider Name (Legal Business Name): CAMACHOMATOSMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 AVE PONCE DE LEON APT 155
SAN JUAN PR
00909-5006
US

IV. Provider business mailing address

PO BOX 851
VEGA ALTA PR
00692-0851
US

V. Phone/Fax

Practice location:
  • Phone: 787-346-2939
  • Fax:
Mailing address:
  • Phone: 787-346-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAEL EMILIO CAMACHO MATOS
Title or Position: CEO
Credential: MD
Phone: 787-346-2939