Doctor Name: | MR. ROBERTO DIAZ CAMARILLO |
NPI Number: | 1134384985 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CADC II |
License Number: | 98-04-08 |
Business Practice Address: | 399 Young Street Woodburn, OR - 97071 |
Business Phone Number: | 5039815265 |
Business Fax Number: | 5039818736 |
Mailing Address: | 399 Young St, WOODBURN |
State: | OR |
Postal Code: | 970714817 |
Phone Number: | 5039815265 |
Fax Number: | |
NPI Enumeration Date: | 07/22/2008 |
NPI Last Update Date: | 07/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 98-04-08 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |