Active NPI
Mary Guadalupe Camacho-Fuentes
- Clinical Social Worker
- Los Angeles, CA
National Provider Identifier
1629235429
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCS 23567
- Practice address
- 2020 Zonal Avenue
Ird Building
Los Angeles, CA 90033 - Phone
- (323) 226-4772
- Fax
- (323) 226-5501
- NPI assigned
- May 20, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCS 23567 | CA | Primary |
Addresses
Primary practice location
2020 Zonal Avenue
Ird Building
Los Angeles, CA 90033
Mailing address
2020 Zonal Avenue
Ird Building
Los Angeles, CA 90033
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCS 23567 | CA | MD | Clinical Social Worker |
| 23567 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1629235429",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 ZONAL AVENUE",
"address_2": "IRD BUILDING",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2020 ZONAL AVENUE",
"address_2": "IRD BUILDING",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90033",
"telephone_number": "323-226-4772",
"fax_number": "323-226-5501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMACHO-FUENTES",
"first_name": "MARY",
"middle_name": "GUADALUPE",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-20",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCS 23567",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.