Provider Demographics
NPI:1780661025
Name:RIOS CAMACHO, LIMARY (MD)
Entity type:Individual
Prefix:DR
First Name:LIMARY
Middle Name:
Last Name:RIOS CAMACHO
Suffix:
Gender:F
Credentials:MD
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 9328
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9328
Mailing Address - Country:US
Mailing Address - Phone:787-743-8730
Mailing Address - Fax:787-745-6133
Practice Address - Street 1:CALLE BAYAMON K-13
Practice Address - Street 2:URB VILLA CARMEN
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-8730
Practice Address - Fax:787-745-6133
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12556208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-9794OtherPTAN
89794Medicare ID - Type Unspecified
G78953Medicare UPIN