Provider Demographics
NPI:1972042919
Name:ORTIZ-CAMACHO, NANCY (LND)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ORTIZ-CAMACHO
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-0764
Mailing Address - Country:US
Mailing Address - Phone:787-531-8296
Mailing Address - Fax:
Practice Address - Street 1:CALLE 345 KM 4.6 INT
Practice Address - Street 2:BO LAVADEROS
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-531-8296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1049133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist