Provider Demographics
NPI:1558585794
Name:JAVIER CAMACHO, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:JAVIER 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 1:201 CALLE GAUTIER BENITEZ
Mailing Address - Street 2:SUITE 031
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5527
Mailing Address - Country:US
Mailing Address - Phone:787-258-3275
Mailing Address - Fax:787-258-3212
Practice Address - Street 1:201 CALLE GAUTIER BENITEZ
Practice Address - Street 2:SUITE 031
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5527
Practice Address - Country:US
Practice Address - Phone:787-258-3275
Practice Address - Fax:787-258-3212
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR119452081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090200Medicare PIN
PRG99101Medicare UPIN