Provider Demographics
NPI:1194779223
Name:JUSINO, CAMILA E (MD)
Entity type:Individual
Prefix:DR
First Name:CAMILA
Middle Name:E
Last Name:JUSINO
Suffix:
Gender:F
Credentials:MD
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 1301
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-1301
Mailing Address - Country:US
Mailing Address - Phone:787-897-1720
Mailing Address - Fax:787-897-2725
Practice Address - Street 1:ROAD 111 KM 1.9
Practice Address - Street 2:LOS PATRIOTAS AVE.
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-1301
Practice Address - Country:US
Practice Address - Phone:787-897-1720
Practice Address - Fax:787-897-2725
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80328Medicaid
PR80328Medicaid