Provider Demographics
NPI:1861483141
Name:CAMACHO PASTOR, IVONNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
Last Name:CAMACHO PASTOR
Suffix:
Gender:F
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:URB LOS VERSALLES REINA DEL SOL 2322
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-831-8336
Mailing Address - Fax:787-834-3380
Practice Address - Street 1:RAMOS ANTONINI ST 162 E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine