Provider Demographics
NPI:1982706354
Name:MILLAN CAMACHO, SANDRA E
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:E
Last Name:MILLAN 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 7717
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7717
Mailing Address - Country:US
Mailing Address - Phone:787-975-9971
Mailing Address - Fax:
Practice Address - Street 1:606 AVE TITO CASTRO STE 225
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-0210
Practice Address - Country:US
Practice Address - Phone:787-843-2029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15003208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22136Medicare ID - Type Unspecified
PRI36889Medicare UPIN