Provider Demographics
NPI:1780439091
Name:CAMARGO, JOSE ANTONIO
Entity type:Individual
Prefix:
First Name:JOSE ANTONIO
Middle Name:
Last Name:CAMARGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JADEN
Other - Middle Name:
Other - Last Name:CAMARGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1968 S COAST HWY # 2862
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-3681
Mailing Address - Country:US
Mailing Address - Phone:909-663-7422
Mailing Address - Fax:
Practice Address - Street 1:1968 S COAST HWY # 2862
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-3681
Practice Address - Country:US
Practice Address - Phone:909-663-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician