=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235859182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN OSCAR CAMACHO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2022
-----------------------------------------------------
Last Update Date | 06/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SENDEROS DEL RIO 860, CARR 175 APT 1125
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-506-5446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SENDEROS DEL RIO 860, CARR 175 APT 1125
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-506-5446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 001058
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 001058-P.A
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------