MEDICARE: ANDREW CAMARENA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	EL1916	CA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E5194	CA

General Provider Information

NPI Number	:	1407106321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW CAMARENA DPM

Provider Business Mailing Address
First Line	:	4758 S BANTAM PASEO
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-5522
Country	:	US
Telephone Number	:	818-667-8269
Fax Number	:

Provider Business Practice Location Address
First Line	:	4758 S BANTAM PASEO
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-5522
Country	:	US
Telephone Number	:	818-667-8269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	10/15/2024

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