Provider Demographics
NPI:1790791804
Name:CAMARENA, JACINTO III (MD)
Entity Type:Individual
Prefix:DR
First Name:JACINTO
Middle Name:
Last Name:CAMARENA
Suffix:III
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 1:345 W STEAMBOAT DR STE 601
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5287
Mailing Address - Country:US
Mailing Address - Phone:605-217-5617
Mailing Address - Fax:605-217-5533
Practice Address - Street 1:345 W STEAMBOAT DR STE 601
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5287
Practice Address - Country:US
Practice Address - Phone:605-217-5617
Practice Address - Fax:605-217-5533
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD142012085R0204X
NY2621322085R0204X
NJ25MA096102002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0491063Medicaid
NJ101024OtherMEDICARE