Provider Demographics
NPI:1265392641
Name:CAMACHO, IVAN JOSEPH (EMT, CHT, NPC)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:JOSEPH
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:EMT, CHT, NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 CATHEDRAL OAKS RD
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1654
Mailing Address - Country:US
Mailing Address - Phone:805-563-0450
Mailing Address - Fax:
Practice Address - Street 1:219 NOGALES AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3848
Practice Address - Country:US
Practice Address - Phone:805-563-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3863836146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic