Provider Demographics
NPI:1750074662
Name:CAMILO, RAPHAEL
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:
Last Name:CAMILO
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 1:801 NEILL AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3031
Mailing Address - Country:US
Mailing Address - Phone:646-796-4523
Mailing Address - Fax:
Practice Address - Street 1:3251 THIRD AVENUE
Practice Address - Street 2:3RD FLOOR SUITE 302
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-708-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator