Provider Demographics
NPI:1134384985
Name:CAMARILLO, ROBERTO DIAZ (CADC II)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:DIAZ
Last Name:CAMARILLO
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-4817
Mailing Address - Country:US
Mailing Address - Phone:503-981-5265
Mailing Address - Fax:
Practice Address - Street 1:399 YOUNG STREET
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071
Practice Address - Country:US
Practice Address - Phone:503-981-5265
Practice Address - Fax:503-981-8736
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR98-04-08101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)