Healthcare Provider Details

I. General information

NPI: 1164037149
Provider Name (Legal Business Name): CAMARENA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16645 ROAD 26
MADERA CA
93638-0830
US

IV. Provider business mailing address

PO BOX 299
MADERA CA
93639-0299
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5625
Mailing address:
  • Phone: 559-664-4000
  • Fax: 559-675-5625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LUZVINDA GABRIELA MARTINEZ
Title or Position: BILLING MANAGER
Credential:
Phone: 559-664-4000