Basic Information
| Provider Information | |||||||||
| NPI: | 1629318795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMARENA | ||||||||
| FirstName: | FABIO | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | JR. | ||||||||
| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 PERKINS DR | ||||||||
| Address2: | STE B | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755266682 | ||||||||
| FaxNumber: | 5756524104 | ||||||||
| Practice Location | |||||||||
| Address1: | 1080 MED PARK DR | ||||||||
| Address2: | STE A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756473773 | ||||||||
| FaxNumber: | 5756473777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2013 | ||||||||
| LastUpdateDate: | 02/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 5280 | NM | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.