Provider Demographics
NPI:1316566177
Name:CAMACHO MATOS, JAEL EMILIO (MD)
Entity Type:Individual
Prefix:
First Name:JAEL
Middle Name:EMILIO
Last Name:CAMACHO MATOS
Suffix:
Gender:M
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:PO BOX 851
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0851
Mailing Address - Country:US
Mailing Address - Phone:787-346-2939
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN CITY HOSPITAL
Practice Address - Street 2:PASEO DR. JOSE CELSO BARBOSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-0092
Practice Address - Country:US
Practice Address - Phone:787-480-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22704208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice