Healthcare Provider Details

I. General information

NPI: 1538612569
Provider Name (Legal Business Name): HOMERO CAMACHO MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2234
  • Fax: 661-862-7682
Mailing address:
  • Phone: 661-326-2234
  • Fax: 661-862-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA166798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: