Healthcare Provider Details

I. General information

NPI: 1831036755
Provider Name (Legal Business Name): JORDAN CAMACHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 LEWELLING BLVD
ASHLAND CA
94580-1632
US

IV. Provider business mailing address

1410 SUTTER CREEK LN
SAN RAMON CA
94583-2677
US

V. Phone/Fax

Practice location:
  • Phone: 800-566-1856
  • Fax:
Mailing address:
  • Phone: 925-413-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN727284
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: