Provider Demographics
NPI:1942088737
Name:CAMACHO REYES, LIXAMARIE (LND)
Entity Type:Individual
Prefix:
First Name:LIXAMARIE
Middle Name:
Last Name:CAMACHO REYES
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB MONTE ALTO
Mailing Address - Street 2:152 CALLE BRITTON
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-4080
Mailing Address - Country:US
Mailing Address - Phone:787-930-2274
Mailing Address - Fax:
Practice Address - Street 1:ISLA VERDE MALL 3ER PISO OFIC 218
Practice Address - Street 2:AVE LOS GOBERNADORES ESQ CALLE DALIA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979
Practice Address - Country:US
Practice Address - Phone:939-332-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered