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NPI Code Detail

MEDICARE: CAROLINA CAMACHO PA-C

MEDICARE: CAROLINA CAMACHO 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 AssistantPA13559TX
2363AM0700XMedical Physician AssistantPA13559TX

General Provider Information

NPI Number : 1861168684
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLINA CAMACHO PA-C
Provider Business Mailing Address
First Line : 4105 SANTA VERONICA ST
Second Line :
City : MISSION
State : TX
Zip : 78572-9748
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3003 NAVIGATION BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77003-1239
Country : US
Telephone Number : 713-223-4466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2021
Last Update Date : 08/20/2021

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Directions to “ CAROLINA CAMACHO PA-C” Practice Location

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