MEDICARE: ADRIENNE PAIGE 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1871266353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE PAIGE CAMACHO

Provider Business Mailing Address
First Line	:	2620 LAS MERCEDES LN
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-7797
Country	:	US
Telephone Number	:	510-650-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 LAS MERCEDES LN
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92879-7797
Country	:	US
Telephone Number	:	510-650-9303
Fax Number	:

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

Provider Enumeration Date	:	07/29/2021
Last Update Date	:	07/29/2021

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Directions to “ ADRIENNE PAIGE CAMACHO ” Practice Location

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