Basic Information
| Provider Information | |||||||||
| NPI: | 1144250622 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMACHO GARCIA | ||||||||
| FirstName: | YAXNA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | CARR. 837 KM. 2.5 BO. SANTA ROSA 1 | ||||||||
| Address2: | |||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872874707 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AVE. GAUTIER BENITEZ ANEXO B-5 | ||||||||
| Address2: | CONSOLIDATED MALL | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | 7877040870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 04/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8630 | PR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.