Provider Demographics
NPI:1033961792
Name:ITO, BODCH TRINIDAD CAMACHO (RN)
Entity Type:Individual
Prefix:MS
First Name:BODCH TRINIDAD
Middle Name:CAMACHO
Last Name:ITO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARIANA HEIGHTS BUSINESS PARK
Mailing Address - Street 2:MH-II BLDG SUITE 100
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:671-475-5827
Mailing Address - Fax:
Practice Address - Street 1:MARIANA HEIGHTS BUSINESS PARK
Practice Address - Street 2:MH-II BLDG SUITE 100
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:671-475-5827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MPR13005163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse