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NPI Code Detail

MEDICARE: NYDIA YARITZA CAMACHO ORTIZ PH. D.

MEDICARE: NYDIA YARITZA CAMACHO ORTIZ PH. D.
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
1103TC0700XClinical Psychologist2946PR
2103TC0700XClinical Psychologist37749TX

General Provider Information

NPI Number : 1265602445
Entity Type Code : Individual
Provider Name (Legal Business Name) : NYDIA YARITZA CAMACHO ORTIZ PH. D.
Provider Business Mailing Address
First Line : 5701 GUNNISON TURN RD
Second Line :
City : AUSTIN
State : TX
Zip : 78738-0009
Country : US
Telephone Number : 787-364-3898
Fax Number :
Provider Business Practice Location Address
First Line : 9500 RAY WHITE RD STE 200
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-9105
Country : US
Telephone Number : 787-364-3898
Fax Number : 833-694-0829
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2008
Last Update Date : 02/27/2024

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