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General NPI Number Information
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NPI Number | 1477399756
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Entity Type | Individual
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Provider Name | BENJAMIN CAMACHO
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Gender | Male
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Dates
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Enumeration Date | 07/05/2024
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 1080 S LA CIENEGA BLVD STE 208
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City | LOS ANGELES
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State | CA
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Zip | 90035-2680
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Country | US
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Telephone | 323-426-6402
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W 116TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90061-1842
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Country | US
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Telephone | 323-601-3268
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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