Provider Demographics
NPI:1457719262
Name:CAMACHO, RAY (DPT)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2775
Mailing Address - Country:US
Mailing Address - Phone:805-583-5975
Mailing Address - Fax:058-583-9578
Practice Address - Street 1:2807 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2775
Practice Address - Country:US
Practice Address - Phone:805-583-9575
Practice Address - Fax:805-583-9578
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2911052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic