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General NPI Number Information
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NPI Number | 1639290125
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Entity Type | Organization
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Legal Business Name | BENJAMIN O. CAMACHO, MD,FACP, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 1615 SWEETWATER RD
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City | NATIONAL CITY
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State | CA
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Zip | 91950-7655
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Country | US
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Telephone | 619-474-2233
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Fax | 619-474-2211
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Provider Business Mailing Address
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Address Line | 1615 SWEETWATER RD
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City | NATIONAL CITY
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State | CA
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Zip | 91950-7655
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Country | US
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Telephone | 619-474-2233
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Fax | 619-474-2211
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Authorized Official
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Title or Position | CEO
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Name | DR. BENJAMIN OCLARINO CAMACHO
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Credential | M.D.
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Telephone | 619-474-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A52660
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License Number State | CA
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