Provider Demographics
NPI:1316962418
Name:CAMARILLO, RIC M (PHD)
Entity type:Individual
Prefix:DR
First Name:RIC
Middle Name:M
Last Name:CAMARILLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:MANUEL
Other - Last Name:CAMARILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LMFT
Mailing Address - Street 1:20072 SW BIRCH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0794
Mailing Address - Country:US
Mailing Address - Phone:949-851-3003
Mailing Address - Fax:949-851-3010
Practice Address - Street 1:20072 SW BIRCH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0799
Practice Address - Country:US
Practice Address - Phone:949-851-3003
Practice Address - Fax:949-851-3010
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22794103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist