Healthcare Provider Details

I. General information

NPI: 1740733534
Provider Name (Legal Business Name): MARTIN ARREOLA CAMACHO BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD
SALINAS CA
93906-3144
US

IV. Provider business mailing address

1826 CHABLIS WAY
GONZALES CA
93926-9237
US

V. Phone/Fax

Practice location:
  • Phone: 831-444-5144
  • Fax:
Mailing address:
  • Phone: 831-800-7530
  • Fax: 831-784-0715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: