=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275680639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RALPH CAMACHO JR MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2007
-----------------------------------------------------
Last Update Date | 08/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5565 WEST LAS POSITAS BLVD SUITE 260
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-5807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-460-0700
-----------------------------------------------------
Fax | 925-734-0517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5565 WEST LAS POSITAS BLVD SUITE 260
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94588-5807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-460-0700
-----------------------------------------------------
Fax | 925-734-0517
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT RALPH CAMACHO JR MD INC
-----------------------------------------------------
Name | DR. RALPH CAMACHO JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 925-460-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | G27622
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | G27622
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------