Provider Demographics
NPI:1275680639
Name:RALPH CAMACHO JR MD INC
Entity Type:Organization
Organization Name:RALPH CAMACHO JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT RALPH CAMACHO JR MD INC
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:925-460-0700
Mailing Address - Street 1:5565 WEST LAS POSITAS BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5807
Mailing Address - Country:US
Mailing Address - Phone:925-460-0700
Mailing Address - Fax:925-734-0517
Practice Address - Street 1:5565 WEST LAS POSITAS BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5807
Practice Address - Country:US
Practice Address - Phone:925-460-0700
Practice Address - Fax:925-734-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27622207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7591118Medicaid
A89456Medicare UPIN
CAZZZ06886ZMedicare PIN