Healthcare Provider Details

I. General information

NPI: 1598324535
Provider Name (Legal Business Name): CARLOS JOSUE SERMENO CAMACHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W 58TH ST
LOS ANGELES CA
90037-3632
US

IV. Provider business mailing address

330 E 3RD ST APT 1101
LONG BEACH CA
90802-3243
US

V. Phone/Fax

Practice location:
  • Phone: 323-541-1600
  • Fax:
Mailing address:
  • Phone: 347-880-9843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA185440
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: