Provider Demographics
NPI:1225499502
Name:CAMACHO-UNDA, PAOLA
Entity Type:Individual
Prefix:MISS
First Name:PAOLA
Middle Name:
Last Name:CAMACHO-UNDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 OLANDA ST
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-5436
Mailing Address - Country:US
Mailing Address - Phone:562-246-5700
Mailing Address - Fax:562-246-5701
Practice Address - Street 1:21520 PIONEER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2604
Practice Address - Country:US
Practice Address - Phone:562-246-5700
Practice Address - Fax:562-246-5701
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker