Healthcare Provider Details

I. General information

NPI: 1245768688
Provider Name (Legal Business Name): MRS. CASSANDRA MARIE CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1621
BALDWIN PARK CA
91706-7621
US

IV. Provider business mailing address

PO BOX 1621
BALDWIN PARK CA
91706-7621
US

V. Phone/Fax

Practice location:
  • Phone: 323-364-5220
  • Fax:
Mailing address:
  • Phone: 626-391-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: