Jessica Melinda Camacho

Key facts

NPI

1104414259

Entity type

Individual (NPI type 1)

Primary specialty

Clinical Social Worker 1041C0700X

License

101205 (CA)

Practice address

4785 N 1St St
Fresno, CA 93726-0513

Phone

(559) 448-4288

NPI assigned

Jan 5, 2021

Sex

Female

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Permanente Medical Group Inc Internal Medicine Physician · Santa Clara, CA · NPI 1073606299
  Medicare reassignment NPD CA
• Permanente Medical Group Inc Internal Medicine Physician · Stockton, CA · NPI 1548343510
  NPD
• Permanente Medical Group, Inc Clinical Medical Laboratory · San Jose, CA · NPI 1497971584
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 23, 2023.

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679529600000",
    "number": "1104414259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4785 N 1ST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937260513",
            "telephone_number": "559-448-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4785 N 1ST ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937260513",
            "telephone_number": "559-448-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMACHO",
        "first_name": "JESSICA",
        "middle_name": "MELINDA",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-05",
        "last_updated": "2023-03-23",
        "certification_date": "2023-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "101205",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "79827",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

• Alaiza Camacho
• Angelita Camacho
• Daisy Monserra Camacho
• Elizabeth Noel Camacho
• Heidi Camacho, LMFT
• Melinda Camacho
• Rosa Yolanda Camacho
• Camarena Health
• Camarena Health
• Guadalupe Camarena

All providers in Fresno, CA · Clinical Social Worker in California