Healthcare Provider Details

I. General information

NPI: 1316566177
Provider Name (Legal Business Name): JAEL EMILIO CAMACHO MATOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 CARR 21
SAN JUAN PR
00921-3399
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 787-782-9999
  • 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 Number22704
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: