Provider Demographics
NPI:1710731302
Name:CAMACHO, CLARISSA (LVN)
Entity Type:Individual
Prefix:MISS
First Name:CLARISSA
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-5400
Mailing Address - Country:US
Mailing Address - Phone:805-265-4894
Mailing Address - Fax:805-856-0343
Practice Address - Street 1:811 W TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-5400
Practice Address - Country:US
Practice Address - Phone:805-265-4894
Practice Address - Fax:805-856-0343
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726311164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse