Provider Demographics
NPI:1356373757
Name:CAMACHO, CECILIA G (AUD, CCC-A)
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:G
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:MS
Other - First Name:CECILIA
Other - Middle Name:G
Other - Last Name:CAMACHO-RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:2814 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6330
Mailing Address - Country:US
Mailing Address - Phone:813-262-1330
Mailing Address - Fax:813-262-1335
Practice Address - Street 1:2814 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6330
Practice Address - Country:US
Practice Address - Phone:813-262-1330
Practice Address - Fax:813-262-1335
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1419231H00000X
FLAZ498 (PROVISIONAL)231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600564100Medicaid
FLCH427ZMedicare UPIN