Healthcare Provider Details

I. General information

NPI: 1255994547
Provider Name (Legal Business Name): HEATHER ANNE CAMARENA RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E GONZALES RD STE 170
OXNARD CA
93036-8215
US

IV. Provider business mailing address

4459 CORTE ARBUSTO
CAMARILLO CA
93012-4048
US

V. Phone/Fax

Practice location:
  • Phone: 805-981-5273
  • Fax:
Mailing address:
  • Phone: 805-403-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number683663
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-49908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: