Healthcare Provider Details

I. General information

NPI: 1902185630
Provider Name (Legal Business Name): CAMARENA HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E ALMOND AVENUE, SUITE 101
MADERA CA
93637-5742
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 TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550001827
License Number StateCA

VIII. Authorized Official

Name: MR. PAULO A SOARES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 559-664-4000