Provider Demographics
NPI:1396205274
Name:CAMACHO, GLORIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 RICHMOND AVE STE 417
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2439
Mailing Address - Country:US
Mailing Address - Phone:281-597-1630
Mailing Address - Fax:281-597-9760
Practice Address - Street 1:12121 RICHMOND AVE STE 417
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2439
Practice Address - Country:US
Practice Address - Phone:281-597-1630
Practice Address - Fax:281-597-9760
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-06-15
Deactivation Date:2020-03-22
Deactivation Code:
Reactivation Date:2022-01-26
Provider Licenses
StateLicense IDTaxonomies
TXT-692047213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist