Provider Demographics
NPI:1659415586
Name:CAMACHO, LYDIA VICTORIA
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:VICTORIA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:
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 500
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-0500
Mailing Address - Country:US
Mailing Address - Phone:787-760-1457
Mailing Address - Fax:
Practice Address - Street 1:12 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-5914
Practice Address - Country:US
Practice Address - Phone:787-761-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3331183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4007678OtherNABP