Provider Demographics
NPI:1922692904
Name:CAMACHO OJEDA, KARIANA YOLANDA
Entity Type:Individual
Prefix:
First Name:KARIANA
Middle Name:YOLANDA
Last Name:CAMACHO OJEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. CAMINOS DEL SUR
Mailing Address - Street 2:GAVIOTA ST 466
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2840
Mailing Address - Country:US
Mailing Address - Phone:787-398-1349
Mailing Address - Fax:
Practice Address - Street 1:URB CAMINOS DEL SUR
Practice Address - Street 2:GAVIOTA ST 466
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2840
Practice Address - Country:US
Practice Address - Phone:787-398-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22165208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice