Basic Information
| Provider Information | |||||||||
| NPI: | 1902185630 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAMARENA HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 299 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936390299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596644000 | ||||||||
| FaxNumber: | 5596755625 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 E ALMOND AVENUE, | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936375742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596644000 | ||||||||
| FaxNumber: | 5596755625 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2011 | ||||||||
| LastUpdateDate: | 04/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | SOARES | ||||||||
| AuthorizedOfficialFirstName: | PAULO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5596644000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QF0400X | 550001827 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.