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NPI Code Detail

MEDICARE: HAZEL DORIBETH CORNEJO CAMACHO

MEDICARE: HAZEL DORIBETH CORNEJO 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
1106H00000XMarriage & Family TherapistLMFT151140CA

General Provider Information

NPI Number : 1821508904
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAZEL DORIBETH CORNEJO CAMACHO
Provider Business Mailing Address
First Line : 18221 E 17TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-2676
Country : US
Telephone Number : 714-730-0930
Fax Number :
Provider Business Practice Location Address
First Line : 18221 E 17TH ST
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-2676
Country : US
Telephone Number : 714-730-0930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2017
Last Update Date : 02/27/2025

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Directions to “ HAZEL DORIBETH CORNEJO CAMACHO ” Practice Location

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