Provider Demographics
NPI:1588721617
Name:CAMARILLO, MAXIMILIAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MAXIMILIAN
Middle Name:
Last Name:CAMARILLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 SEACLIFF DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4444
Mailing Address - Country:US
Mailing Address - Phone:831-688-6870
Mailing Address - Fax:831-688-6870
Practice Address - Street 1:550 WATER ST STE F2
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4131
Practice Address - Country:US
Practice Address - Phone:831-429-5826
Practice Address - Fax:831-429-5826
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10845103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist