Provider Demographics
NPI:1851537633
Name:APONTE-CAMACHO, ILEANA (MD)
Entity Type:Individual
Prefix:MS
First Name:ILEANA
Middle Name:
Last Name:APONTE-CAMACHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ILEANA
Other - Middle Name:
Other - Last Name:APONTE-CAMACHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11310 S ORANGE BLOSSOM TRL STE 109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9421
Mailing Address - Country:US
Mailing Address - Phone:407-413-3200
Mailing Address - Fax:
Practice Address - Street 1:4365 HUNTERS PARK LN # 10
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7614
Practice Address - Country:US
Practice Address - Phone:407-413-3200
Practice Address - Fax:407-286-4419
Is Sole Proprietor?:No
Enumeration Date:2008-12-27
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17450208D00000X
FLACN573208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA127XOtherMEDICARE UPIN
FL013503400Medicaid