Healthcare Provider Details

I. General information

NPI: 1245167915
Provider Name (Legal Business Name): PAOLA DAJANNA CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 ARMSDALE AVE
LA MIRADA CA
90638-1003
US

IV. Provider business mailing address

11808 ARMSDALE AVE
LA MIRADA CA
90638-1003
US

V. Phone/Fax

Practice location:
  • Phone: 562-441-7186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number7331538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: