Provider Demographics
NPI:1871640235
Name:CAMACHO, RALPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RALPH
Other - Middle Name:
Other - Last Name:CAMACHO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5565 WEST LAS POSITAS BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94558-5807
Mailing Address - Country:US
Mailing Address - Phone:925-460-0700
Mailing Address - Fax:925-734-0517
Practice Address - Street 1:5565 WEST LAS POSITAS BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94558-5807
Practice Address - Country:US
Practice Address - Phone:925-460-0700
Practice Address - Fax:925-734-0517
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27622207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7591118Medicaid
A89456Medicare UPIN
CA00G276222Medicare PIN