Provider Demographics
NPI:1578766382
Name:CAMACHO MONTALVO, DARYNELL (MD)
Entity Type:Individual
Prefix:
First Name:DARYNELL
Middle Name:
Last Name:CAMACHO MONTALVO
Suffix:
Gender:F
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 268
Mailing Address - Street 2:GARROCHALES
Mailing Address - City:GARROCHALES
Mailing Address - State:PR
Mailing Address - Zip Code:00652-0268
Mailing Address - Country:US
Mailing Address - Phone:787-505-6951
Mailing Address - Fax:787-815-3391
Practice Address - Street 1:CARR 682 KM 6.0
Practice Address - Street 2:GARROCHALES
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00652-0268
Practice Address - Country:US
Practice Address - Phone:787-505-6951
Practice Address - Fax:787-815-3391
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15215208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice