Provider Demographics
NPI:1942928163
Name:CARRILLO-CAMACHO, JANET (RN, PHN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:CARRILLO-CAMACHO
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:1350 AVENIDA ARANA
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7332
Mailing Address - Country:US
Mailing Address - Phone:760-936-6206
Mailing Address - Fax:
Practice Address - Street 1:1350 AVENIDA ARANA
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7332
Practice Address - Country:US
Practice Address - Phone:760-936-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554052364SC1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health