Provider Demographics
NPI:1275613424
Name:CAMACHO, MARTIN (APRN-RX, ACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:APRN-RX, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 PUNCHBOWL ST
Mailing Address - Street 2:HOSPITALIST PROGRAM
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2402
Mailing Address - Country:US
Mailing Address - Phone:808-691-7657
Mailing Address - Fax:808-691-5033
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2402
Practice Address - Country:US
Practice Address - Phone:808-691-7657
Practice Address - Fax:808-691-5033
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPOO8067363L00000X
HIRN-73940163WE0003X, 163WC0200X
HIAPRN-1571363LA2100X, 363LC0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine