Healthcare Provider Details

I. General information

NPI: 1952244584
Provider Name (Legal Business Name): CAMILLE MANGUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 N PALM AVE STE 103
FRESNO CA
93704-2233
US

IV. Provider business mailing address

6975 E GARLAND AVE
FRESNO CA
93727-0905
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-1737
  • Fax:
Mailing address:
  • Phone: 708-262-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: