MEDICARE: DR. RICHARD O CAMACHO MD

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	207R00000X	Internal Medicine Physician	A93056	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649253881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD O CAMACHO MD

Provider Business Mailing Address
First Line	:	1805 N CALIFORNIA ST STE 406
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6033
Country	:	US
Telephone Number	:	209-227-7806
Fax Number	:	209-851-3853

Provider Business Practice Location Address
First Line	:	1805 N CALIFORNIA ST STE 406
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6033
Country	:	US
Telephone Number	:	209-227-7806
Fax Number	:	209-851-3853

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	10/28/2018

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