Provider Demographics
NPI:1669681722
Name:CAMACHO, LOURDES (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSIONES DEL CARIBE II
Mailing Address - Street 2:219 CALLE AMATISTA
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-5223
Mailing Address - Country:US
Mailing Address - Phone:787-553-5053
Mailing Address - Fax:
Practice Address - Street 1:MANSIONES DEL CARIBE II
Practice Address - Street 2:219 CALLE AMATISTA
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-5223
Practice Address - Country:US
Practice Address - Phone:787-553-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist