Provider Demographics
NPI:1114593563
Name:CAMACHO-VASCONEZ, GABRIELA (LAC)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:
Last Name:CAMACHO-VASCONEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 SCHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ALPHA
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-4269
Mailing Address - Country:US
Mailing Address - Phone:484-536-9197
Mailing Address - Fax:
Practice Address - Street 1:101 S 3RD ST STE 203
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4524
Practice Address - Country:US
Practice Address - Phone:484-536-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2023-06-01
Deactivation Date:2021-05-27
Deactivation Code:
Reactivation Date:2021-09-03
Provider Licenses
StateLicense IDTaxonomies
PAAK001345171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist