Healthcare Provider Details

I. General information

NPI: 1861154460
Provider Name (Legal Business Name): MARIA ISABEL CAMACHO MARRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 MEADOWLANDS DR STE 1-2
WHITE BEAR LAKE MN
55127-2339
US

IV. Provider business mailing address

8660 ABLE ST NE
BLAINE MN
55434-2323
US

V. Phone/Fax

Practice location:
  • Phone: 612-445-0300
  • Fax:
Mailing address:
  • Phone: 939-415-7659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: