Provider Demographics
NPI:1962126425
Name:CAMACHO SANCHEZ, MARIANGEL
Entity type:Individual
Prefix:
First Name:MARIANGEL
Middle Name:
Last Name:CAMACHO SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 TALISI LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9167
Mailing Address - Country:US
Mailing Address - Phone:689-777-6891
Mailing Address - Fax:
Practice Address - Street 1:545 TALISI LOOP
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-9167
Practice Address - Country:US
Practice Address - Phone:689-777-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-207316106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician