Provider Demographics
NPI:1689271298
Name:GARCIA DE CAMACHO, MA. LUISA
Entity Type:Individual
Prefix:
First Name:MA.
Middle Name:LUISA
Last Name:GARCIA DE CAMACHO
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 1:1450 MARKET ST APT 449
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-4160
Mailing Address - Country:US
Mailing Address - Phone:916-226-7129
Mailing Address - Fax:
Practice Address - Street 1:1450 MARKET ST APT 449
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4160
Practice Address - Country:US
Practice Address - Phone:916-226-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37059225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist