Provider Demographics
NPI:1679756399
Name:CAMACHO, JOHANNA MILITZA (MD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MILITZA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 E OSCEOLA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1910
Mailing Address - Country:US
Mailing Address - Phone:407-847-7910
Mailing Address - Fax:
Practice Address - Street 1:996 E OSCEOLA PARKWAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3474
Practice Address - Country:US
Practice Address - Phone:407-847-7910
Practice Address - Fax:407-932-2432
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice