Healthcare Provider Details

I. General information

NPI: 1427720465
Provider Name (Legal Business Name): GIOVANNI EMMANUEL CAMACHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KNOLLCREST DR STE 101
REDDING CA
96002-0181
US

IV. Provider business mailing address

PO BOX 25991
FRESNO CA
93729-5991
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-2322
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: