Provider Demographics
NPI:1619941622
Name:CAMACHO, HECTOR E (ATC/L, EMT-B)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:E
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:ATC/L, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 ASPENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-8801
Mailing Address - Country:US
Mailing Address - Phone:407-348-2131
Mailing Address - Fax:
Practice Address - Street 1:311 W BASS ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5011
Practice Address - Country:US
Practice Address - Phone:407-870-5959
Practice Address - Fax:407-933-6468
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL308951146N00000X
FLAL16202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer