Healthcare Provider Details

I. General information

NPI: 1811611957
Provider Name (Legal Business Name): LUZ ELENA CAMACHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 6TH AVE
SAN DIEGO CA
92103-4790
US

IV. Provider business mailing address

3840 6TH AVE APT 511
SAN DIEGO CA
92103-4794
US

V. Phone/Fax

Practice location:
  • Phone: 619-816-8353
  • Fax:
Mailing address:
  • Phone: 619-816-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2608559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: