Healthcare Provider Details

I. General information

NPI: 1396735395
Provider Name (Legal Business Name): JOSE DANIEL CAMACHO RODRIGUEZ PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND THE EXECUTIVE #623 AVE PONCE DE LEON APT 1101-B
SAN JUAN PR
00917
US

IV. Provider business mailing address

1 CALLE HNOS RODRIGUEZ EMA APT 1105
CAROLINA PR
00979-5809
US

V. Phone/Fax

Practice location:
  • Phone: 787-934-0752
  • Fax: 787-728-7398
Mailing address:
  • Phone: 787-934-0752
  • Fax: 787-728-7398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1272
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1272
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1272
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: