Provider Demographics
NPI:1184338451
Name:CAMACHO, DARYL TOLENTINO
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:TOLENTINO
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 DULALAS LOOP # 506
Mailing Address - Street 2:
Mailing Address - City:YIGO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-2411
Mailing Address - Country:US
Mailing Address - Phone:671-929-6416
Mailing Address - Fax:
Practice Address - Street 1:643 CHALAN SAN ANTONIO
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3644
Practice Address - Country:US
Practice Address - Phone:671-735-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULX0513164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse