Provider Demographics
NPI:1851753396
Name:RAMIREZ CAMACHO, CORAL
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:RAMIREZ 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 1:7827 CLOS DU BOIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4880
Mailing Address - Country:US
Mailing Address - Phone:253-576-1406
Mailing Address - Fax:
Practice Address - Street 1:7827 CLOS DU BOIS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4880
Practice Address - Country:US
Practice Address - Phone:253-576-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-17-7871106E00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No174400000XOther Service ProvidersSpecialist