MEDICARE: MS. MARIA DE LA LUZ CAMACHO RDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	RDA90299	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033675350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA DE LA LUZ CAMACHO RDA

Provider Business Mailing Address
First Line	:	11212 FLALLON AVE
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-1621
Country	:	US
Telephone Number	:	562-277-5710
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 N LAKEWOOD BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-1558
Country	:	US
Telephone Number	:	562-420-1701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	02/12/2019

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