Provider Demographics
NPI:1265602445
Name:CAMACHO ORTIZ, NYDIA YARITZA (PH D)
Entity type:Individual
Prefix:
First Name:NYDIA
Middle Name:YARITZA
Last Name:CAMACHO ORTIZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 GUNNISON TURN RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-0009
Mailing Address - Country:US
Mailing Address - Phone:787-364-3898
Mailing Address - Fax:
Practice Address - Street 1:9500 RAY WHITE RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9105
Practice Address - Country:US
Practice Address - Phone:787-364-3898
Practice Address - Fax:833-694-0829
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2946103TC0700X
TX37749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical