Provider Demographics
NPI:1194928549
Name:CAMARILLO, CHRISELDA LEIGH
Entity type:Individual
Prefix:MRS
First Name:CHRISELDA
Middle Name:LEIGH
Last Name:CAMARILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 NW 143RD AVE APT C16
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8128
Mailing Address - Country:US
Mailing Address - Phone:503-439-0369
Mailing Address - Fax:
Practice Address - Street 1:3431 SE 36TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1817
Practice Address - Country:US
Practice Address - Phone:503-863-5901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker