MEDICARE: MIGUEL A CAMACHO M.A, CDE

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	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1215061395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL A CAMACHO M.A, CDE

Provider Business Mailing Address
First Line	:	7201 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5523
Country	:	US
Telephone Number	:	503-240-3917
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 N INTERSTATE AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5523
Country	:	US
Telephone Number	:	503-240-3917
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/16/2007

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