Provider Demographics
NPI:1467756536
Name:BRENDA M.K. CAMACHO M.D. LLC
Entity Type:Organization
Organization Name:BRENDA M.K. CAMACHO M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MICHIKO
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-935-1621
Mailing Address - Street 1:615 PONAHAWAI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7665
Mailing Address - Country:US
Mailing Address - Phone:808-935-1621
Mailing Address - Fax:808-935-5959
Practice Address - Street 1:615 PONAHAWAI ST STE 201
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7665
Practice Address - Country:US
Practice Address - Phone:808-935-1621
Practice Address - Fax:808-935-5959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9518261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI002084-02Medicaid
HI002084-02Medicaid