Provider Demographics
NPI:1811538291
Name:CAMACHO, LILIANA YASMIN
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:YASMIN
Last Name: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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-0130
Mailing Address - Country:US
Mailing Address - Phone:479-986-5150
Mailing Address - Fax:
Practice Address - Street 1:3307 N DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-6816
Practice Address - Country:US
Practice Address - Phone:479-986-5150
Practice Address - Fax:479-986-5191
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty