Provider Demographics
NPI:1073030441
Name:GONZALEZ-CAMACHO, JASMIN (BCMBT, LMT)
Entity Type:Individual
Prefix:MS
First Name:JASMIN
Middle Name:
Last Name:GONZALEZ-CAMACHO
Suffix:
Gender:F
Credentials:BCMBT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2252
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-2252
Mailing Address - Country:US
Mailing Address - Phone:787-379-7772
Mailing Address - Fax:
Practice Address - Street 1:153-A MARGINAL FORTUNA
Practice Address - Street 2:
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773
Practice Address - Country:US
Practice Address - Phone:787-465-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-27
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMAS8027225700000X
GAMT010105225700000X
FLMA68855225700000X
PR718225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist