Healthcare Provider Details

I. General information

NPI: 1356140875
Provider Name (Legal Business Name): GUADALUPE CAMARENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5377 N FRESNO ST STE 103
FRESNO CA
93710-6874
US

IV. Provider business mailing address

1824 W VERNON AVE
LOS ANGELES CA
90062-1556
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9244
  • Fax:
Mailing address:
  • Phone: 310-401-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: