Basic Information
Provider Information
NPI: 1285281741
EntityType: 2
ReplacementNPI:  
OrganizationName: CAMARENA HEALTH
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 299
Address2:  
City: MADERA
State: CA
PostalCode: 936390299
CountryCode: US
TelephoneNumber: 5596644000
FaxNumber: 5596755625
Practice Location
Address1: 49165 ROAD 426
Address2:  
City: OAKHURST
State: CA
PostalCode: 936448621
CountryCode: US
TelephoneNumber: 5596644000
FaxNumber: 5596755625
Other Information
ProviderEnumerationDate: 08/20/2019
LastUpdateDate: 08/20/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SOARES
AuthorizedOfficialFirstName: PAULO
AuthorizedOfficialMiddleName: A.
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 5596644000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MHA
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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