Provider Demographics
NPI:1790777282
Name:CAMACHO CUEVAS, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:CAMACHO CUEVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 CALLE SAN CLAUDIO
Mailing Address - Street 2:PMB 254
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4143
Mailing Address - Country:US
Mailing Address - Phone:787-293-0205
Mailing Address - Fax:787-293-0205
Practice Address - Street 1:1779 CARR 844
Practice Address - Street 2:URB LITHEDA HEIGHTS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4434
Practice Address - Country:US
Practice Address - Phone:787-293-0205
Practice Address - Fax:787-293-0205
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11836208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41666Medicare PIN