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NPI Code Detail

MEDICARE: LETICIA CAMACHO-STOVERN PA-C

MEDICARE: LETICIA CAMACHO-STOVERN PA-C
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
1363A00000XPhysician AssistantPA3045FL
2363A00000XPhysician Assistant004975-01NY
3363A00000XPhysician Assistant25MP00739700NJ

General Provider Information

NPI Number : 1598729071
Entity Type Code : Individual
Provider Name (Legal Business Name) : LETICIA CAMACHO-STOVERN PA-C
Provider Business Mailing Address
First Line : 69 LEBER AVE
Second Line :
City : CARTERET
State : NJ
Zip : 07008-1942
Country : US
Telephone Number : 386-747-6007
Fax Number :
Provider Business Practice Location Address
First Line : 5141 BROADWAY
Second Line :
City : NEW YORK
State : NY
Zip : 10034-1159
Country : US
Telephone Number : 212-932-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 10/02/2023

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Directions to “ LETICIA CAMACHO-STOVERN PA-C” Practice Location

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