Provider Demographics
NPI:1114972544
Name:CAMACHO PADILLA, NIDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDIA
Middle Name:
Last Name:CAMACHO PADILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 CAMINO ALEJANDRINO
Mailing Address - Street 2:SUITE 102 FONTAIN BLUE PLAZA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-7038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 CALLE MENDEZ VIGO
Practice Address - Street 2:SUITE 202
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4800
Practice Address - Country:US
Practice Address - Phone:787-278-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13311207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22447Medicare ID - Type UnspecifiedNUMERO PROVEEDOR
PRH50459Medicare UPIN