MEDICARE: MRS. JIA LI CAMACHO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	LBA1094	NV

General Provider Information

NPI Number	:	1174286801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JIA LI CAMACHO

Provider Business Mailing Address
First Line	:	7108 SOUTH KANNER HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7462
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

Provider Business Practice Location Address
First Line	:	871 CORONADO CENTER DR
Second Line	:	SUITE 200
City	:	HENDERSON
State	:	NV
Zip	:	89052-3977
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	12/13/2025

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