Healthcare Provider Details

I. General information

NPI: 1063224749
Provider Name (Legal Business Name): MR. JESUS H CAMARENA III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5329 OFFICE CENTER CT
BAKERSFIELD CA
93309-7425
US

IV. Provider business mailing address

1075 CREEKSIDE RIDGE DR STE 280
ROSEVILLE CA
95678-3504
US

V. Phone/Fax

Practice location:
  • Phone: 661-864-7010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: