Healthcare Provider Details

I. General information

NPI: 1144865833
Provider Name (Legal Business Name): BRENDA CARCAMO-ALMENDAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA CARCAMO

II. Dates (important events)

Enumeration Date: 11/17/2019
Last Update Date: 11/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37772 AQUARIUS CIR
PALMDALE CA
93552-3612
US

IV. Provider business mailing address

37772 AQUARIUS CIR
PALMDALE CA
93552-3612
US

V. Phone/Fax

Practice location:
  • Phone: 310-259-9718
  • Fax:
Mailing address:
  • Phone: 310-259-9718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA92216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: