Healthcare Provider Details

I. General information

NPI: 1942971601
Provider Name (Legal Business Name): MELINDA CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 E WILLETTA ST
PHOENIX AZ
85006-2723
US

IV. Provider business mailing address

3017 N 310TH LN
BUCKEYE AZ
85396-6766
US

V. Phone/Fax

Practice location:
  • Phone: 480-581-3900
  • Fax:
Mailing address:
  • Phone: 602-473-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number242261
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: