Provider Demographics
NPI:1851694913
Name:CAMARILLO, DEBRA
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:CAMARILLO
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 1:1001 SNEATH LN STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-244-1444
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:1001 SNEATH LN STE 210
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:650-244-1444
Practice Address - Fax:650-244-1447
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2586-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)