Provider Demographics
NPI:1659423358
Name:CAMACHO, LUIS (PA)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 COLLIER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-3550
Mailing Address - Country:US
Mailing Address - Phone:239-732-0044
Mailing Address - Fax:239-732-0094
Practice Address - Street 1:8625 COLLIER BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3550
Practice Address - Country:US
Practice Address - Phone:239-732-0044
Practice Address - Fax:239-732-0094
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103060207N00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5403928OtherAETNA
FLP1019782OtherFRREDOM
FL4697435OtherCIGNA
FL1249033OtherWELLCARE
FLP958309OtherOPTIMUM
FLY0H9MOtherBCBS OF FL
FLP1019782OtherFRREDOM
FL398576OtherAVMED
FL5403928OtherAETNA
FL398576OtherAVMED
FLQ48698Medicare UPIN