Healthcare Provider Details

I. General information

NPI: 1003706565
Provider Name (Legal Business Name): MICHELLE ROMERO CAMARILLO CERTIFIED MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 CONCORD AVE
MADERA CA
93637
US

IV. Provider business mailing address

1219 CONCORD AVE
MADERA CA
93637
US

V. Phone/Fax

Practice location:
  • Phone: 559-871-4963
  • Fax:
Mailing address:
  • Phone: 559-871-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: