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General NPI Number Information
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NPI Number | 1255156907
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Entity Type | Individual
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Provider Name | JOSE EFRAIN CAMACHO
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Gender | Male
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 3924 RIVERVIEW DR
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City | JURUPA VALLEY
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State | CA
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Zip | 92509-6611
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Country | US
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Telephone | 951-360-4175
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Fax |
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Provider Business Mailing Address
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Address Line | 3924 RIVERVIEW DR
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City | JURUPA VALLEY
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State | CA
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Zip | 92509-6611
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Country | US
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Telephone | 951-360-4175
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | NA
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License Number State |
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-QRYLMA
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License Number State | CA
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