Provider Demographics
NPI:1619052636
Name:CAMILO, LEE MELISSA (TECH)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:MELISSA
Last Name:CAMILO
Suffix:
Gender:F
Credentials:TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G14 CALLE 3A
Mailing Address - Street 2:URB. VILLAS DE LOIZA
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-4201
Mailing Address - Country:US
Mailing Address - Phone:787-256-4443
Mailing Address - Fax:
Practice Address - Street 1:G14 CALLE 3A
Practice Address - Street 2:URB. VILLAS DE LOIZA
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-4201
Practice Address - Country:US
Practice Address - Phone:787-256-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005217183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician