Provider Demographics
NPI:1336984160
Name:CAMARILLO AVILES, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CAMARILLO AVILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3177
Mailing Address - Country:US
Mailing Address - Phone:509-433-4199
Mailing Address - Fax:
Practice Address - Street 1:1261 CHERRY ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3177
Practice Address - Country:US
Practice Address - Phone:509-433-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist