Provider Demographics
NPI:1396735395
Name:CAMACHO RODRIGUEZ, JOSE DANIEL (PH D)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DANIEL
Last Name:CAMACHO RODRIGUEZ
Suffix:
Gender:M
Credentials:PH D
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Mailing Address - Street 1:1 CALLE HNOS RODRIGUEZ EMA
Mailing Address - Street 2:APT 1105
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5809
Mailing Address - Country:US
Mailing Address - Phone:787-934-0752
Mailing Address - Fax:787-728-7398
Practice Address - Street 1:COND THE EXECUTIVE
Practice Address - Street 2:#623 AVE PONCE DE LEON APT 1101-B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-934-0752
Practice Address - Fax:787-728-7398
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR1272103TC1900X, 103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR03619OtherAMERICAN HEALTH
PR100518OtherLA CRUZ AZUL
PR1748OtherAPS HEALTHCARE (REFORMA)
PRP-784OtherINTERNATIONAL MEDICAL CARD
PR520053OtherFHC
PR2728OtherMMM
PR2475OtherHUMANA
PR219029OtherPREFERRED HEALTH
PR005-6729Medicare ID - Type Unspecified
PR219029OtherPREFERRED HEALTH