=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841495454
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AILEEN CAMACHO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2007
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CONSOLIDATED TRIBAL HEALTH 6991 N. STATE ST.
-----------------------------------------------------
City | REDWOOD VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95470-9629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-485-5115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6991 N STATE ST
-----------------------------------------------------
City | REDWOOD VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95470-9629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-485-5115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 019041
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------