MEDICARE: SANDRA CAMACHO RN

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	163W00000X	Registered Nurse	RN506632	CA

General Provider Information

NPI Number	:	1790991792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA CAMACHO RN

Provider Business Mailing Address
First Line	:	1515 FRUITVALE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-2322
Country	:	US
Telephone Number	:	510-535-4000
Fax Number	:	510-535-4128

Provider Business Practice Location Address
First Line	:	3451 E 12TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3425
Country	:	US
Telephone Number	:	510-535-3600
Fax Number	:	510-535-4247

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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