Provider Demographics
NPI:1417369620
Name:CAMACHO REHABILITATION INC
Entity Type:Organization
Organization Name:CAMACHO REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-567-0153
Mailing Address - Street 1:4800 W FLAGLER ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1400
Mailing Address - Country:US
Mailing Address - Phone:305-567-0153
Mailing Address - Fax:305-567-0921
Practice Address - Street 1:4800 W FLAGLER ST STE 110
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1400
Practice Address - Country:US
Practice Address - Phone:305-567-0153
Practice Address - Fax:305-567-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04740FLMedicare PIN