Provider Demographics
NPI:1518680644
Name:CORREA CAMACHO, AIDA MIRIAM (DACM)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:MIRIAM
Last Name:CORREA CAMACHO
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:DR
Other - First Name:HEIDY
Other - Middle Name:
Other - Last Name:CORREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DACM, DOM, HWP
Mailing Address - Street 1:HC 2 BOX 12442
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-8263
Mailing Address - Country:US
Mailing Address - Phone:787-431-3979
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 125 KM 12.5 INTERIOR
Practice Address - Street 2:BARRIO CAPA SECTOR LASALLE
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-431-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR171100000X
FL171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171100000XOther Service ProvidersAcupuncturist