Provider Demographics
NPI:1639290125
Name:BENJAMIN O. CAMACHO, MD,FACP, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BENJAMIN O. CAMACHO, MD,FACP, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:OCLARINO
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-474-2233
Mailing Address - Street 1:1615 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7655
Mailing Address - Country:US
Mailing Address - Phone:619-474-2233
Mailing Address - Fax:619-474-2211
Practice Address - Street 1:1615 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7655
Practice Address - Country:US
Practice Address - Phone:619-474-2233
Practice Address - Fax:619-474-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52660207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A526601Medicaid
CAF90895Medicare UPIN
CA00A526601Medicaid