Healthcare Provider Details

I. General information

NPI: 1699498626
Provider Name (Legal Business Name): WENDY CAMARENA-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CAPITOL AVE
LITTLE ROCK AR
72201-3436
US

IV. Provider business mailing address

400 W CAPITOL AVE STE 1700
LITTLE ROCK AR
72201-3438
US

V. Phone/Fax

Practice location:
  • Phone: 501-613-0385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: