Healthcare Provider Details

I. General information

NPI: 1932015807
Provider Name (Legal Business Name): MARISELA CAMACHO TEJEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 LIGHTHOUSE AVE STE 324
MONTEREY CA
93940-1010
US

IV. Provider business mailing address

111 DIVISION ST SPC 6
KING CITY CA
93930-3026
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 831-737-5429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: