Provider Demographics
NPI:1972105955
Name:CAMACHO, GLORIA NICOLE
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:NICOLE
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 1:8535 FLORENCE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4071
Mailing Address - Country:US
Mailing Address - Phone:562-261-5538
Mailing Address - Fax:
Practice Address - Street 1:8535 FLORENCE AVE STE 200
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4071
Practice Address - Country:US
Practice Address - Phone:562-261-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63252355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty