Provider Demographics
NPI:1407855398
Name:GONZALEZ-CAMACHO, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:GONZALEZ-CAMACHO
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 8646
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8646
Mailing Address - Country:US
Mailing Address - Phone:787-318-6451
Mailing Address - Fax:787-283-2307
Practice Address - Street 1:ROAD #2
Practice Address - Street 2:SUITE 301
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7217
Practice Address - Country:US
Practice Address - Phone:787-778-6195
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7224207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD99588Medicare UPIN