Healthcare Provider Details

I. General information

NPI: 1487751715
Provider Name (Legal Business Name): CAMINO REAL COMMUNITY MHMR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19965 FM 3175 NORTH
LYTLE TX
78052
US

IV. Provider business mailing address

PO BOX 725
LYTLE TX
78052-0725
US

V. Phone/Fax

Practice location:
  • Phone: 210-357-0300
  • Fax: 210-357-0458
Mailing address:
  • Phone: 210-357-0300
  • Fax: 210-357-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberNONE
License Number State

VIII. Authorized Official

Name: ANDREA CORONA
Title or Position: REIMBURSEMENT SPECIALIST
Credential:
Phone: 210-357-0369