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General NPI Number Information
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NPI Number | 1073030441
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Entity Type | Individual
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Provider Name | JASMIN GONZALEZ-CAMACHO BCMBT, LMT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2017
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 153-A MARGINAL FORTUNA
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City | LUQUILLO
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State | PR
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Zip | 00773
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Country | US
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Telephone | 787-465-0819
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2252
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City | FAJARDO
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State | PR
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Zip | 00738-2252
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Country | US
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Telephone | 787-379-7772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS8027
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT010105
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA68855
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 718
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License Number State | PR
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