Provider Demographics
NPI:1912288176
Name:CAMACHO, ERIN ANGELA VILLAGOMEZ (RD)
Entity Type:Individual
Prefix:
First Name:ERIN ANGELA
Middle Name:VILLAGOMEZ
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5029
Mailing Address - Street 2:CHRB
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-287-8934
Mailing Address - Fax:
Practice Address - Street 1:504768 C.K. BEACH ROAD
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-235-2030
Practice Address - Fax:670-235-2033
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
984144133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered