Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | L3934 | TX |
NPI | 1295716025 |
---|---|
Provider Name | Maria T Camacho |
First Address | Harlingen, TX 78553-4358 |
Second Address | Harlingen, TX 78552-6235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 10/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
155603701 | (05) | TX |
155603706 | (05) | TX |
H74762 | (02) | TX |