Healthcare Provider Details

I. General information

NPI: 1851207211
Provider Name (Legal Business Name): JASON DANIEL CAMACHO MS, PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N SAN PEDRO RD
SAN RAFAEL CA
94903-4200
US

IV. Provider business mailing address

2775 11TH ST
SAN PABLO CA
94806-2267
US

V. Phone/Fax

Practice location:
  • Phone: 415-492-3150
  • Fax:
Mailing address:
  • Phone: 562-396-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: