MEDICARE: VICTOR CAMILO RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	644353	TX
2	163WC0200X	Critical Care Medicine Registered Nurse	644353	TX
3	163WC1500X	Community Health Registered Nurse	644353	TX
4	163WE0003X	Emergency Registered Nurse	644353	TX
5	163WG0000X	General Practice Registered Nurse	644353	TX
6	163WH0200X	Home Health Registered Nurse	644353	TX
7	163WM0705X	Medical-Surgical Registered Nurse	644353	TX
8	163WP2201X	Ambulatory Care Registered Nurse	644353	TX
9	163WW0000X	Wound Care Registered Nurse	644353	TX
10	163WX0200X	Oncology Registered Nurse	644353	TX
11	163WX1500X	Ostomy Care Registered Nurse	644353	TX
12	163W00000X	Registered Nurse	644353	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	644353	OTHER	TX	RN LICENSE

General Provider Information

NPI Number	:	1073096764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR CAMILO RN

Provider Business Mailing Address
First Line	:	2735 NACOGDOCHES RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5830
Country	:	US
Telephone Number	:	210-225-1115
Fax Number	:	210-225-1114

Provider Business Practice Location Address
First Line	:	2735 NACOGDOCHES RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5830
Country	:	US
Telephone Number	:	210-225-1115
Fax Number	:	210-225-1114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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Directions to “ VICTOR CAMILO RN” Practice Location

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