Provider Demographics
NPI:1316668262
Name:CAMACHO, YAMILETTE (SLP)
Entity type:Individual
Prefix:
First Name:YAMILETTE
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 CALLE MONTE ESCARCHA
Mailing Address - Street 2:PRADERA DEL RIO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-963-9063
Mailing Address - Fax:
Practice Address - Street 1:3289 CALLE MONTE ESCARCHA
Practice Address - Street 2:PRADERA DEL RIO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-963-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty