Provider Demographics
NPI:1790879187
Name:JARAMILLO, CAMILA S (MD)
Entity Type:Individual
Prefix:
First Name:CAMILA
Middle Name:S
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1019 COTTONWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6751
Mailing Address - Country:US
Mailing Address - Phone:505-857-3957
Mailing Address - Fax:505-715-5554
Practice Address - Street 1:1019 COTTONWOOD DR NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6751
Practice Address - Country:US
Practice Address - Phone:505-857-3957
Practice Address - Fax:505-715-5554
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM29401232Medicaid
NM29401232Medicaid
341314301Medicare PIN