Healthcare Provider Details

I. General information

NPI: 1861652414
Provider Name (Legal Business Name): E'LAINA MARIE CAMINO MHAIII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3077 FITE CIR STE 6
SACRAMENTO CA
95827-1815
US

IV. Provider business mailing address

3077 FITE CIR STE 6
SACRAMENTO CA
95827-1815
US

V. Phone/Fax

Practice location:
  • Phone: 916-854-1801
  • Fax: 916-854-1809
Mailing address:
  • Phone: 916-854-1801
  • Fax: 916-854-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: