Healthcare Provider Details

I. General information

NPI: 1174792196
Provider Name (Legal Business Name): BETHANY KAREN ARMENDARIZ RN, WHCNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2008
Last Update Date: 02/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 MADRESELVA CT
CAMARILLO CA
93012-6816
US

IV. Provider business mailing address

461 MADRESELVA CT
CAMARILLO CA
93012-6816
US

V. Phone/Fax

Practice location:
  • Phone: 714-290-1061
  • Fax:
Mailing address:
  • Phone: 714-290-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number17064
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: