Healthcare Provider Details

I. General information

NPI: 1104387778
Provider Name (Legal Business Name): ADRIANA BUGARIN CAMACHO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 CHERRY AVE STE 27 #1123
SAN BRUNO CA
94066-2954
US

IV. Provider business mailing address

851 CHERRY AVE STE 27 #1123
SAN BRUNO CA
94066-2954
US

V. Phone/Fax

Practice location:
  • Phone: 415-580-1765
  • Fax:
Mailing address:
  • Phone: 415-580-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC6038
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC18256
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAPCC6038
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: