Basic Information
| Provider Information | |||||||||
| NPI: | 1316566177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMACHO MATOS | ||||||||
| FirstName: | JAEL | ||||||||
| MiddleName: | EMILIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 851 | ||||||||
| Address2: | |||||||||
| City: | VEGA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006920851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873462939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SAN JUAN CITY HOSPITAL | ||||||||
| Address2: | PASEO DR. JOSE CELSO BARBOSA | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009210092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874802700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2020 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 22704 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.