Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | P2206 | TX |
NPI | 1215297247 |
---|---|
Provider Name | Randal Matthew Camarillo |
First Address | Houston, TX 77030-1526 |
Second Address | Katy, TX 77494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 05/11/2020 |