Provider Demographics
NPI:1851056659
Name:CAMACHO, JOCELYN R
Entity Type:Individual
Prefix:MISS
First Name:JOCELYN
Middle Name:R
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 1:9229 SEPULVEDA BLVD APT 104
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-6954
Mailing Address - Country:US
Mailing Address - Phone:818-671-8277
Mailing Address - Fax:
Practice Address - Street 1:9229 SEPULVEDA BLVD APT 104
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-6954
Practice Address - Country:US
Practice Address - Phone:818-671-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician