Provider Demographics
NPI:1073096764
Name:CAMILO, VICTOR (RN)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:CAMILO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:CAMILO SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:2735 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5830
Mailing Address - Country:US
Mailing Address - Phone:210-225-1115
Mailing Address - Fax:210-225-1114
Practice Address - Street 1:2735 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5830
Practice Address - Country:US
Practice Address - Phone:210-225-1115
Practice Address - Fax:210-225-1114
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644353163WA2000X, 163WC0200X, 163WC1500X, 163WE0003X, 163WG0000X, 163WH0200X, 163WM0705X, 163WP2201X, 163WW0000X, 163WX0200X, 163WX1500X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX644353OtherRN LICENSE