MEDICARE: CAMILLE MANGUERRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95038953	CA

General Provider Information

NPI Number	:	1952244584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE MANGUERRA

Provider Business Mailing Address
First Line	:	6975 E GARLAND AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-0905
Country	:	US
Telephone Number	:	708-262-2395
Fax Number	:

Provider Business Practice Location Address
First Line	:	5240 N PALM AVE STE 103
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93704-2233
Country	:	US
Telephone Number	:	559-268-1737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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Directions to “ CAMILLE MANGUERRA ” Practice Location

Language	Start Address	Practice Location

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