Provider Demographics
NPI:1487161493
Name:HERNANDEZ, CAMILLE GERMAINE GARCHITORENA (MSLP, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE GERMAINE
Middle Name:GARCHITORENA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSLP, CF-SLP
Other - Prefix:MS
Other - First Name:CAMILLE GERMAINE
Other - Middle Name:GARCHITORENA
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8454 E MILAGRO CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-7316
Mailing Address - Country:US
Mailing Address - Phone:714-872-1504
Mailing Address - Fax:
Practice Address - Street 1:108 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5818
Practice Address - Country:US
Practice Address - Phone:480-668-1917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP11181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ388418Medicaid