Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 11945 | PR |
Y | 213ES0000X | Sports Medicine | 11945 | PR |
NPI | 1558585794 |
---|---|
Provider Name | Eric Javier Camacho |
First Address | Caguas, PR 00725-5527 |
Second Address | Caguas, PR 00725-5527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 11/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G99101 | (02) | PR |