Healthcare Provider Details

I. General information

NPI: 1356278477
Provider Name (Legal Business Name): JACQUELINE CAMARENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77711 FLORA RD STE 327
PALM DESERT CA
92211-4103
US

IV. Provider business mailing address

1132 S ALTHEA AVE
RIALTO CA
92376-7455
US

V. Phone/Fax

Practice location:
  • Phone: 626-313-8421
  • Fax:
Mailing address:
  • Phone:
  • 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: