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General NPI Number Information
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NPI Number | 1174236087
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Entity Type | Individual
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Provider Name | JORGE FRANCISCO CAMARILLO
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Gender | Male
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 6340 N AZALEA AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4001
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Country | US
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Telephone | 323-382-8274
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Fax |
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Provider Business Mailing Address
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Address Line | 6340 N AZALEA AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-4001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95023636
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License Number State | CA
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