Healthcare Provider Details

I. General information

NPI: 1871395236
Provider Name (Legal Business Name): OMAR CAMACHO PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB REPARTO CONTEMPORANEO CALLE E D 12
SAN JUAN PR
00926-1212
US

IV. Provider business mailing address

URB REPARTO CONTEMPORANEO CALLE E D 12
SAN JUAN PR
00926-1212
US

V. Phone/Fax

Practice location:
  • Phone: 484-697-8918
  • Fax:
Mailing address:
  • Phone: 484-697-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1553-P
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: