Healthcare Provider Details

I. General information

NPI: 1689611873
Provider Name (Legal Business Name): WILLIAM DE JESUS CAMACHO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 111 INT 123
UTUADO PR
00641-2091
US

IV. Provider business mailing address

PO BOX 2091
UTUADO PR
00641-2091
US

V. Phone/Fax

Practice location:
  • Phone: 787-933-6703
  • Fax: 787-933-6703
Mailing address:
  • Phone: 787-933-6703
  • Fax: 787-933-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberTCAMB326
License Number StatePR

VIII. Authorized Official

Name: MRS. WILLIAM DE JESUS
Title or Position: OWNER SHIP
Credential:
Phone: 787-933-6703