Healthcare Provider Details

I. General information

NPI: 1700704699
Provider Name (Legal Business Name): MARISSA ANGELLA CAMARENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 PROFESSIONAL CIR STE 125
RENO NV
89521-3100
US

IV. Provider business mailing address

4959 TALBOT LN APT 192
RENO NV
89509-6518
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-7300
  • Fax: 855-253-3789
Mailing address:
  • Phone: 775-348-7300
  • Fax: 855-253-3789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number889166
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: