Provider Demographics
NPI:1326182254
Name:MARTINEZ CAMACHO, JOSE L (LICD)
Entity Type:Individual
Prefix:PROF
First Name:JOSE L
Middle Name:
Last Name:MARTINEZ CAMACHO
Suffix:
Gender:M
Credentials:LICD
Other - Prefix:PROF
Other - First Name:JOSE L
Other - Middle Name:MARTINEZ
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICD
Mailing Address - Street 1:MIGRANT HEALTH CENTER, INC.
Mailing Address - Street 2:P O BOX 7128
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7128
Mailing Address - Country:US
Mailing Address - Phone:787-805-2900
Mailing Address - Fax:787-834-1924
Practice Address - Street 1:MIGRANT HEALTH CENTER, INC.
Practice Address - Street 2:392 SUR CALLE RAMON EMETERIO BETANCES
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-805-2900
Practice Address - Fax:787-834-1924
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3220246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031095OtherNUM PROVEEDOR