Provider Demographics
NPI:1972133361
Name:CAMACHO, ELIZABETH QUILITIS
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:QUILITIS
Last Name:CAMACHO
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:PO BOX 1606
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-1606
Mailing Address - Country:US
Mailing Address - Phone:671-477-5782
Mailing Address - Fax:
Practice Address - Street 1:127 2ND ST OCEAN VISTA TIYAN
Practice Address - Street 2:
Practice Address - City:MAITE
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-477-5782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULX0360164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse