MEDICARE: JESENIA 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	126800000X	Dental Assistant	02177895	CA

General Provider Information

NPI Number	:	1235456823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESENIA CAMACHO

Provider Business Mailing Address
First Line	:	15120 PIONEER BLVD
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-6449
Country	:	US
Telephone Number	:	562-440-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 WILSHIRE BLVD
Second Line	:	1111
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-1902
Country	:	US
Telephone Number	:	310-820-9933
Fax Number	:

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

Provider Enumeration Date	:	04/22/2010
Last Update Date	:	04/22/2010

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Directions to “ JESENIA CAMACHO ” Practice Location

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