Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CH60841231 | WA |
NPI | 1649776949 |
---|---|
Provider Name | Juan Ramon Camacho |
First Address | Grandview, WA 98930-1334 |
Second Address | Prosser, WA 99350-9515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 04/04/2018 |