Provider Demographics
NPI:1629365838
Name:MAYSONET-CAMACHO, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:MAYSONET-CAMACHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 MAR INDICO STREET
Mailing Address - Street 2:PASEO LOS CORALES 1
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4802
Mailing Address - Country:US
Mailing Address - Phone:787-278-0037
Mailing Address - Fax:
Practice Address - Street 1:673 MAR INDICO STREET
Practice Address - Street 2:PASEO LOS CORALES 1
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4802
Practice Address - Country:US
Practice Address - Phone:787-278-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist