Provider Demographics
NPI:1760436968
Name:CAMACHO PEREZ-ARCE, HECTOR G (PA-C)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:G
Last Name:CAMACHO PEREZ-ARCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27512 CALLE ARROYO
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2753
Mailing Address - Country:US
Mailing Address - Phone:206-714-1733
Mailing Address - Fax:949-489-9342
Practice Address - Street 1:27512 CALLE ARROYO
Practice Address - Street 2:SUITE A
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2753
Practice Address - Country:US
Practice Address - Phone:206-714-1733
Practice Address - Fax:949-489-9342
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004193363A00000X
CAPA19017363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8322521Medicaid
WAP45066Medicare UPIN
WA8322521Medicaid