Provider Demographics
NPI:1427157973
Name:CAMACHO, CLAUDIA SUSANA (MD)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:SUSANA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27699 JEFFERSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2661
Mailing Address - Country:US
Mailing Address - Phone:951-252-8588
Mailing Address - Fax:951-252-8589
Practice Address - Street 1:44274 GEORGE CUSHMAN CT
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5945
Practice Address - Country:US
Practice Address - Phone:951-587-0992
Practice Address - Fax:951-587-0993
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80621208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A806210OtherMEDI-CAL PROVIDER NUMBER
CA00A806210OtherMEDI-CAL PROVIDER NUMBER