Provider Demographics
NPI:1699759936
Name:CAMACHO, BENJAMIN OCLARINO (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:OCLARINO
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SWEETWATER RD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7655
Mailing Address - Country:US
Mailing Address - Phone:619-474-2233
Mailing Address - Fax:619-474-2211
Practice Address - Street 1:1615 SWEETWATER RD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-474-2233
Practice Address - Fax:619-474-2211
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052660207RC0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A526600Medicaid
F90895Medicare UPIN
CAA52660Medicare ID - Type Unspecified