Healthcare Provider Details

I. General information

NPI: 1548158264
Provider Name (Legal Business Name): RYLEY SPENCER CAMACHO ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 COX RD STE 300
GLEN ALLEN VA
23060-3320
US

IV. Provider business mailing address

4101 COX RD STE 300
GLEN ALLEN VA
23060-3320
US

V. Phone/Fax

Practice location:
  • Phone: 804-210-3100
  • Fax: 804-210-3105
Mailing address:
  • Phone: 804-210-3100
  • Fax: 804-210-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: