MEDICARE: RICHARD CAMACHO CUEVAS M.D.

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	208D00000X	General Practice Physician	11836	PR

General Provider Information

NPI Number	:	1790777282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CAMACHO CUEVAS M.D.

Provider Business Mailing Address
First Line	:	352 CALLE SAN CLAUDIO
Second Line	:	PMB 254
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4143
Country	:	US
Telephone Number	:	787-293-0205
Fax Number	:	787-293-0205

Provider Business Practice Location Address
First Line	:	1779 CARR 844
Second Line	:	URB LITHEDA HEIGHTS
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4434
Country	:	US
Telephone Number	:	787-293-0205
Fax Number	:	787-293-0205

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	12/10/2010

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