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NPI Code Detail

MEDICARE: SANDRA CAMACHO

MEDICARE: SANDRA CAMACHO
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1588492813
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA CAMACHO
Provider Business Mailing Address
First Line : 506 W GRAHAM AVE STE 106
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-3665
Country : US
Telephone Number : 714-989-3681
Fax Number :
Provider Business Practice Location Address
First Line : 506 W GRAHAM AVE STE 106
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92530-3665
Country : US
Telephone Number : 714-989-3681
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2024
Last Update Date : 07/26/2024

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Directions to “ SANDRA CAMACHO ” Practice Location

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