Provider Demographics
NPI:1285037374
Name:CAMACHO RUIZ, CAROLINA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:CAMACHO RUIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 COND WHITE TOWER ST SE APT 709
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-405-0435
Mailing Address - Fax:
Practice Address - Street 1:COND WHITE TOWER # 1049SE
Practice Address - Street 2:APT 709
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3062
Practice Address - Country:US
Practice Address - Phone:787-405-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304458207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine