Basic Information
| Provider Information | |||||||||
| NPI: | 1740733534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARREOLA CAMACHO | ||||||||
| FirstName: | MARTIN | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1826 CHABLIS WAY | ||||||||
| Address2: | |||||||||
| City: | GONZALES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939269237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8318007530 | ||||||||
| FaxNumber: | 8317840715 | ||||||||
| Practice Location | |||||||||
| Address1: | 1270 NATIVIDAD RD | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314445144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2016 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.