Jose Daniel Camacho Rodriguez, PH. D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1272 Issued in PR

Practice address

Cond the Executive
#623 Ave Ponce de Leon Apt 1101-B
San Juan, PR 00917

Phone

(787) 934-0752

Fax

(787) 728-7398

NPI assigned

Oct 21, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in PR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1396735395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CALLE HNOS RODRIGUEZ EMA",
            "address_2": "APT 1105",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "009795809",
            "telephone_number": "787-934-0752",
            "fax_number": "787-728-7398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "COND THE EXECUTIVE",
            "address_2": "#623 AVE PONCE DE LEON APT 1101-B",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "00917",
            "telephone_number": "787-934-0752",
            "fax_number": "787-728-7398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMACHO RODRIGUEZ",
        "first_name": "JOSE",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "PH. D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "PR",
            "license": "1272",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "PR",
            "license": "1272",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "1272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN HEALTH",
            "identifier": "03619",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA CRUZ AZUL",
            "identifier": "100518",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APS HEALTHCARE (REFORMA)",
            "identifier": "1748",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNATIONAL MEDICAL CARD",
            "identifier": "P-784",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FHC",
            "identifier": "520053",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MMM",
            "identifier": "2728",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "2475",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED HEALTH",
            "identifier": "219029",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Camacho Cuevas, M.D.
• Lorell Camacho del Valle
• Migdelys Camacho Jimenez, MS, SLP
• Jael Emilio Camacho Matos, MD
• Coralis Dessiree Camacho Nieves
• Carolina Camacho Ruiz
• Lydia M. Camacho-Capo, PSY. D.
• Kamille V Camacho-Monclova, NL
• Sandra Camacho-Otero, M.D.
• Yazmin Camacho-Rivera

• Clinical Psychologist in San Juan, PR
• Providers in San Juan, PR by specialty
• Clinical Psychologist in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.