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General NPI Number Information
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NPI Number | 1245085240
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Entity Type | Individual
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Provider Name | EDWARD CHRISTIAN MIANO CAMACHO PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 5940 W UNION HILLS DR STE B100
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City | GLENDALE
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State | AZ
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Zip | 85308-1313
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Country | US
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Telephone | 602-755-7858
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Fax |
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Provider Business Mailing Address
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Address Line | 4549 S SQUIRES LN UNIT 201
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City | GILBERT
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State | AZ
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Zip | 85297-2330
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Country | US
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Telephone | 615-330-0162
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Fax | 623-440-5695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 464615
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 305830
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 305830
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License Number State | AZ
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