MEDICARE: MS. CAROLINA CAMACHO PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1457439804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLINA CAMACHO PA

Provider Business Mailing Address
First Line	:	402 N CHICAGO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1829
Country	:	US
Telephone Number	:	323-893-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1528
Country	:	US
Telephone Number	:	323-263-2669
Fax Number	:	323-263-2673

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	03/04/2014

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