Provider Demographics
NPI:1295872273
Name:CAMACHO, JOCELY
Entity type:Individual
Prefix:MR
First Name:JOCELY
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOCELY
Other - Middle Name:
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:HC 58 BOX 13728
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9724
Mailing Address - Country:US
Mailing Address - Phone:787-390-8533
Mailing Address - Fax:
Practice Address - Street 1:HC 58 BOX 13728
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-9724
Practice Address - Country:US
Practice Address - Phone:787-390-8533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5941183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician