Healthcare Provider Details

I. General information

NPI: 1164144945
Provider Name (Legal Business Name): KARLA CAMACHO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV MADERO 834 STE 4
MEXICALI BAJA CALIFORNIA
21100
MX

IV. Provider business mailing address

2013 DAIRY MART RD UNIT 3
SAN YSIDRO CA
92173-1848
US

V. Phone/Fax

Practice location:
  • Phone: 619-209-8924
  • Fax: 916-625-1368
Mailing address:
  • Phone: 619-209-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: DENTAL CLAIMS MANAGER
Credential:
Phone: 619-209-8924