Provider Demographics
NPI:1417093840
Name:CAMACHO, RODRIGO (PSYCH TECH)
Entity Type:Individual
Prefix:MR
First Name:RODRIGO
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:PSYCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34230 90TH ST EAST
Mailing Address - Street 2:
Mailing Address - City:LITLLE ROCK
Mailing Address - State:CA
Mailing Address - Zip Code:93543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2720 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4930
Practice Address - Country:US
Practice Address - Phone:661-947-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27341167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician