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General NPI Number Information
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NPI Number | 1881993012
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Entity Type | Individual
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Provider Name | MARIA MAGDALENA CAMACHO MSW
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Gender | Female
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 516 S PARK AVE
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City | SHELLEY
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State | ID
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Zip | 83274-1434
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Country | US
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Telephone | 702-823-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 E ROME BLVD BLDG 26 APT 1134
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89086-1309
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Country | US
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Telephone | 208-403-1560
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-35453
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License Number State | ID
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