Rebecca Shelley Camacho

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

125084180 Issued in IL

Practice address

2535 Kettner Blvd Ste 1A4
San Diego, CA 92101-1252

Phone

(619) 615-0701

NPI assigned

Aug 30, 2018

Reactivated

Jun 13, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: rebecca.camacho.1@16494.direct.athenahealth.com

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

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1871075457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 KETTNER BLVD STE 1A4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921011252",
            "telephone_number": "619-615-0701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2535 KETTNER BLVD STE 1A4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921011252",
            "telephone_number": "619-615-0701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMACHO",
        "first_name": "REBECCA",
        "middle_name": "SHELLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-30",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "deactivation_date": "2024-05-02",
        "reactivation_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125084180",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125084180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karina Camacho, RBT
• Kassandra Camacho
• Katrina Camacho
• Luz Elena Camacho
• Nora Mary Camacho, BCBA
• Ronald Camacho
• Samantha Camacho
• Silke Alexa Camacho
• Talya Camacho
• Thomas John Camacho Jr., IDC

• Family Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.