Healthcare Provider Details

I. General information

NPI: 1396205274
Provider Name (Legal Business Name): GLORIA CAMACHO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date: 03/22/2020
Reactivation Date: 01/26/2022

III. Provider practice location address

255 N GILBERT ST
HEMET CA
92543-4066
US

IV. Provider business mailing address

PO BOX 843270
LOS ANGELES CA
90084-3270
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-4386
  • Fax: 951-925-4947
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberT-692047
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number6207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: